PurposeThere are a paucity of data and a pressing need to evaluate response to neoadjuvant chemotherapy (NACT) and determine long-term outcomes in young Black women with early-stage breast cancer (EBC).MethodsWe analyzed data from 2196 Black and White women with EBC treated at the University of Chicago over the last 2 decades. Patients were divided into groups based on race and age at diagnosis: Black women\documentclass[12pt]{minimal}
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				\begin{document}$$\le$$\end{document}≤40 years, White women\documentclass[12pt]{minimal}
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				\begin{document}$$\le$$\end{document}≤40 years, Black women\documentclass[12pt]{minimal}
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				\begin{document}$$\ge$$\end{document}≥55 years, and White women\documentclass[12pt]{minimal}
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				\begin{document}$$\ge$$\end{document}≥55 years. Pathological complete response rate (pCR) was analyzed using logistic regression. Overall survival (OS) and disease-free survival (DFS) were analyzed using Cox proportional hazard and piecewise Cox models.ResultsYoung Black women had the highest risk of recurrence, which was 22% higher than young White women (p= 0.434) and 76% higher than older Black women (p= 0.008). These age/racial differences in recurrence rates were not statistically significant after adjusting for subtype, stage, and grade. In terms of OS, older Black women had the worst outcome. In the 397 women receiving NACT, 47.5% of young White women achieved pCR, compared to 26.8% of young Black women (p= 0.012).ConclusionsBlack women with EBC had significantly worse outcomes compared to White women in our cohort study. There is an urgent need to understand the disparities in outcomes between Black and White breast cancer patients, particularly in young women where the disparity in outcome is the greatest.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10549-023-06943-x.