Abstract: The worse outcomes in African-American (AA) breast cancer patients have been attributed to a variety of factors, including compliance/variations with treatment. We evaluated a large cohort of AA patients treated with breast conservation therapy (BCT) in an effort to determine if compliance with radiation or if choice of chemotherapy regimen could be a contributing factor for the worse outcomes reported in AA patients. Our two cohorts consisted of 221 AA and 2170 white patients treated with BCT. Chart reviews were conducted to document dates of treatment, treatment breaks, dose delivered, and chemotherapy delivered. The data were analyzed to detect differences between the two cohorts. The median radiation dose delivered (including cone-down) was 64 Gy in both cohorts (p = 0.9910). The median number of treatment days was: AA, 45 (range 21–71 days) versus white, 45 (range 14–90 days; p = 0.8465). The chemotherapy regimens administered were: adriamycin/cytoxan (17% AA versus 19% white, respectively), adriamycin/cytoxan/taxol (13% versus 5%), cytoxan/methotrexate/5-FU (53% versus 59%), cytoxan/methotrexate/5-FU/vincristine (0% versus 3%), cytoxan/adriamycin/5-FU (12% versus 11%), high dose/transplant (0% versus 1%), and other (4% versus 5%), p = 0.113. Our large institutional series suggests that compliance with radiation therapy, once patients are seen in consultation and simulated, does not differ significantly between AA and white patients. In our large cancer center environment, AA patients referred for radiation therapy appear to receive the same radiation doses in a comparable time frame to white patients. Further exploration of compliance for adjuvant chemotherapy regimens in AA patients is warranted.