Objective: Increased incidence and mortality of colorectal cancer in African Americans (AA) is well documented and has led to targeted education and screening programs within this population. Complicated colorectal cancers (CCC), defined as obstructing or perforating lesions, have worse prognosis and are preventable with colrectal cancer screening. The purpose of this study is to assess whether racial disparities, despite initiatives in education and screening, remain within a cohort of patients presenting with CCC. Methods: A retrospective study of 522 patients undergoing surgery for colorectal cancer of which 72 (13.8%) were CCC was performed. Exclusion criteria included age less than 18, diagnosis of inflammatory bowel disease, familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, and diagnosis of colorectal cancer greater than one-year prior to presentation. Four patients were excluded based on these criteria. Significance was determined by unpaired t-test, chi-square and ANOVA analysis.Results: Of the 522 patients, 319 were Caucasian (CA), 51 AA, and 152 “other” (Hispanic, Asian or race not identified) of which 72 (13.8%) were CCC. Of the 68 patients who qualified for the study, 11 were AA, 38 CA and 17 other. 4.4% of patients had been screened in the past for colorectal cancer, no difference between AA and CA. AA were twice as likely as CA to present with CCC (22.2% vs. 11.9%, p>0.05), however significance was not met. Significance was demonstrated in socioeconomic parameters and gender. AA with CCC were more likely in lower income brackets (36.4% vs. 0%, p<0.001) and insured solely through Medicaid or Medicare (54.5% vs. 15.8%, p<0.012) than CA. AA women had increased incidence of CCC as compared to CA women (90.9 vs. 36.8%, p<0.002). Tumor stage, location, postoperative outcome, and mortality rate was equivalent in all patient populations.Conclusion: Despite measures to improve education and screening, disparity in preventable CCC still exists. AA in low-income brackets with government subsidized insurance are more likely to present with CCC. AA women have increased incidence of complicated cancer when compared to CA women. Increased colorectal cancer screening and education should be targeted to AA women and AA in low-income neighborhoods.