Colorectal cancer is the second leading cause of cancer mortality in the United States. Recently, there has been a small, but palpable decline in colorectal cancer incidence and mortality; yet for black patients the rate of decline has been less than half as great as for whites. In this article, the authors investigated racial variation in the performance of sphincter-sparing procedures for patients with stage II and III rectal cancer who underwent surgery. They drew data for patients with rectal cancer from the National Cancer Institute-funded Surveillance Epidemiology and End Results (SEER) database (n = 3,851 black patients; 44,010 white patients). The study used race as a primary predictor variable, with outcome variables including the proportion of patients undergoing any surgical treatment; the proportion of patients undergoing a sphincter-sparing procedure versus abdominoperineal resection; and the delivery of neoadjuvant irradiation. Analysis of the data indicated that disease was detected in blacks at a significantly younger age and in a more advanced stage compared with whites. A smaller proportion of blacks than whites underwent surgery; and of those that opted for surgery, a significantly greater proportion of blacks underwent a sphincter-abating procedure. The authors suggest that further studies are warranted to investigate the relationships among race, treatment, and ultimately, survival, controlling for patient- and provider-related variables. This journal article is available free-of-charge.