Background: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is a surrogate predictor for long-term survival in breast cancer (BC). Patients who attain pCR have improved relapse-free and overall survival (OS) when compared to patients with residual disease (RD). We examined the pCR in Black and White BC patients who received NACT and their OS after attaining pCR and RD. Methods: The National Cancer Database (NCDB) was queried for Black and White females with non-metastatic BC from the years 2010 – 2016 who received NACT. Logistic regression was used to analyze pCR/RD and Cox proportional hazards regression to analyze OS, with adjustment for age, race, stage, grade, body mass index, treatments received, insurance status and comorbidities. STATA/IC 16.0 was used for analysis and a two-sided p-value < 0.05 was considered significant. Results: A total of 101,014 White and Black BC patients were identified, including 24,852 (Whites - 74.43%, Black - 25.57%) triple negative breast cancer (TNBC), 51,043 (Whites - 84%, Blacks - 16%) hormone receptor positive HER2 negative (HR+HER2-) and 17,818 (Whites - 83%, Blacks - 17%) HER2 positive. Whites had a slightly higher odds of attaining pCR compared to Blacks (adjusted Odds Ratio (aOR) = 1.040, 95% Confidence Interval (CI) = 1.02 - 1.19, p = 0.02). The difference was largest in TNBC subtype (TNBC: aOR = 1.34, 95% CI = 1.20 - 1.56, p < 0.001; HR+HER2-: aOR = 1.1; 95% CI = 1.02 - 1.32, p = 0.038; HER2+: aOR = 1.13, 95% CI = 1.08 - 1.27, p < 0.001). Among those who attained pCR, Blacks had worse OS when compared to Whites in HER2+ subtype (adjusted Hazard Ratio (aHR) = 1.41, 95% CI = 1.04 - 1.93, p = 0.028) but not in TNBC or HR+HER2- subtypes. Among those with RD, Blacks had worse OS in the whole cohort compared to Whites (aHR = 1.43, 95% CI = 1.26 - 1.58, p < 0.001), and in all subtypes: TNBC (aHR = 1.17, 95% CI = 1.11 - 1.23, p < 0.001), HR+HER2- (aHR = 1.38, 95% CI = 1.31 - 1.45, p < 0.001) and HER2+ (aHR = 1.45, 95% CI = 1.32 - 1.59, p < 0.001). Conclusions: Black BC patients with TNBC were less likely to achieve pCR than Whites after NACT. When Black patients with HER2+ subtype did attain pCR, they still had worse OS than Whites. The same racial difference in OS was observed in all BC subtypes - TNBC, HR+HER2- and HER2+ among patients with RD. This highlights the importance to investigate novel personalized treatment strategies for Black patients.