Background: The incidence of breast cancer is higher in Caucasian (C) compared to African American (AA) patients (pts), however the mortality is higher in AA. This disparity has been explained by a higher stage at diagnosis, triple negative tumors, high nuclear grade, and decreased access to health care among the AA women pts. This difference still persists when these factors are controlled. We hypothesized that AA pts have reduced dose intensity of chemotherapy due to treatment delays and dose reductions as a result of increased acute toxicity leading to inferior outcomes. Methods: Data was collected by retrospective chart review on 100 consecutive C and 100 AA pts with early stage breast cancer who received adjuvant or neoadjuvant chemotherapy during 2009 to 2011 at a community cancer center. Data collected included pt demographics, comorbidities, disease characteristics, treatment received, acute toxicities, and pt reported symptom burden as assessed by a validated electronic survey. Results: Mean age of C and AA pts was 56.1 vs. 51.5, respectively (p = .0049). All pts had ECOG performance status of 0-1, with no race differences. AA pts had higher rates of diabetes (17.0% vs. 11.9%) and hypertension (49.0% vs. 36.6%). The mean Charlson Comorbidity Index score was 3.1 for C and 3.4 for AA (p = .064). 44% of C presented at stage II and III as compared to 61% of AA patients (p = .028). AA had higher tumor grade (p = .005) . For chemotherapy AA got numerically more dose dense AC-paclitaxel, similar docetaxel-cyclophosphamide and less cyclophosphamide-methotrexate-5FU as compared to C. Most common side effects for C and AA respectively were, anemia: 50.5% vs. 68%, neutropenia: 14.9% vs. 12%, nausea: 27% vs. 15%, diarrhea: 13.9% vs. 11%, infection: 13.9% vs. 14% and neuropathy: 16.8% vs. 13%. Treatment delays and dose reductions did not differ between race groups. Patient reported symptom burden also did not differ among race groups. Conclusions: Despite difference in comorbidities and stage at presentation, no significant difference was observed in acute toxicities due to chemotherapy, in pt reported symptoms or the rates of chemotherapy delay and dose reduction between C and AA pts with early stage breast cancer.