Racial disparities in breast cancer subtypes, recurrence, and survival: a longitudinal cohort analysis

Racial disparities in breast cancer subtype distribution and clinical outcomes are well documented, yet integrated longitudinal analyses examining subtype, recurrence, and survival within standardized cohorts remain limited. This study examines race-associated differences in breast cancer subtypes, recurrence patterns, and survival outcomes using a retrospective longitudinal cohort.

A total of 922 women from the Duke Breast Cancer MRI dataset were analyzed. Race was categorized a priori into three groups (White, Black, and Other) for primary comparative analyses.

The median age at diagnosis (in years) was 52.2 (IQR 45.4-60.8), with Black patients presenting at younger median ages compared with White patients (p< 0.001). Black women had the highest prevalence of triple-negative breast cancer (29.6%). Sixty-five (47.1%) of black patients presented with stage III Nottingham grade at presentation (P< 0.001). The overall recurrence rate was 9.4%, and mortality rate was 6.7%, with no statistically significant difference between groups.

Black patients demonstrated a higher prevalence of aggressive tumor biology at presentation; however, survival differences were attenuated after multivariable adjustment. Given the limited number of mortality events, adjusted survival estimates should be interpreted cautiously, as these findings underscore the need for larger, prospective studies integrating genomic, imaging, and socioeconomic data to better define drivers of outcome disparities in breast cancer.