Purpose: Racial disparities in breast cancer treatment and survival are well established. However, the impact of living in racially segregated areas on cancer outcomes is not well-understood. The purpose of this study is to demonstrate the extent to which racial segregation is associated with the odds of receiving surgery and five year survival for patients diagnosed with breast cancer (BC). This is a retrospective, cohort study of BC patients in Georgia (2000-2007; N= 30,811) using data from the Georgia Comprehensive Cancer Registry. Method: The patient level data were merged with Census 2000 data. Isolation index was used to operationalize racial segregation at the census tract level. This index captures the probability of living in proximity to individuals from the same racial group and varies from 0 to 1 where higher scores indicate higher level of isolation. We conducted logistic regression and survival analyses where in all models age, race, tumor stage, tumor grade, and estrogen receptor status were controlled. Additionally, we controlled for neighborhood characteristics including residential stability, elderly concentration, levels of rurality, and educational status. Results: Black women have 38% deceased odds of receiving surgery compared to white women (95% CI: 0.53-0.72). Living in most racially segregated areas was associated with 21% decreased odds of receiving surgery (95% CI: 0.65-0.98). The significant association of surgery with both race and racial segregation disappeared after we controlled for the interaction between race and racial segregation. Black women had also 23% increased risk of death compared to white patients (95% CI: 1.15-1.32). Living in most segregated areas was associated with 20% increased risk of death (95% CI: 1.09-1.31). After controlling for the interaction between race and racial segregation, race was not significant anymore but living in the most racially segregated areas remained as a risk factor for BC death (HR=1.20; 95% CI: 1.06-1.36). Conclusion: Our findings suggest that it is not race per se that explains cancer disparities between white and black in BC outcomes. The poorer BC outcomes for black women should be understood within the social and spatial constructs where structural inequality may explain limited access to proper treatment regimens.