PROJECT SUMMARY American Indians and Alaska Natives (AIs/ANs) and U.S.-born Hispanic Americans (HAs) have aheavier burden of kidney cancer than non-Hispanic Whites (NHWs). They often have multiple barriers to healthcare and they are often diagnosed with more advanced stage kidney cancer. Early detection and timelysurgical treatment with a minimally invasive surgical method likely reduce kidney cancer health disparities.However kidney cancer health disparities research focuses on differences in clinical characteristics betweenNHWs and non-Hispanic Blacks often using national-level data ignoring heterogeneity across U.S. regions orsubpopulations. AIs/ANs and HAs are underrepresented in kidney cancer clinical studies and risk factors fordiagnosis with advanced stage kidney cancer and mortality among these racial/ethnic groups are not wellunderstood. Moreover there is no qualitative study in AIs/ANs and HAs to identify factors that affect surgicaltreatment that AI/AN and HA patients receive and if they are contributing to high mortality. The goal of this study is to identify causes of kidney cancer surgical disparities using a mixed methodapproach combining semi-structured in-depth interviews and analysis of clinical data at local- state- andnational-levels using data from Banner University Medical Center Arizona Cancer Registry and the NationalCancer Database. We hypothesize that compared to NHWs AIs and HAs have poor understanding of cancerand kidney cancer symptoms and experience more barriers in health care which results in advanced stagecancer diagnosis delay of care delivery of less optimal treatments and ultimately poorer survival. Qualitativeand quantitative methods will be used respectively in Specific Aims (SA) 1 and 2 to explore how differentlythat AIs and HAs or HA subgroups experience the kidney cancer surgical disparities. To identify knowledgegaps in kidney cancer secondary and tertiary prevention and barriers to care one-hour semi-structured in-depth interviews will be conducted to assess understanding of kidney cancer symptoms diagnosis care andsocial determinants of health with kidney cancer patients (n=50) individuals without cancer in communitysettings (n=50) and community urologists and health care providers (n=10) in minority servicing primary careclinics (SA 1). Differences in clinical characteristics at diagnosis and types and timing of surgical care receivedbetween AI HA patients and NHW patients will be determined and then associations between thesedifferences and overall survival will be assessed (SA2). The results from SA1 and SA2 will be integrated todevelop a theory of kidney cancer surgical disparities. Our long-term goal is to develop intervention studies to improve kidney cancer care in racial/ethnicminority groups with a heavy kidney cancer burden. This study will identify specific areas to focus on to reduceknowledge gaps and barriers to care and develop a theory on kidney cancer surgical disparities to be tested.Culturally-adapted materials will be developed to educate AI/AN and HA patients in clinical settings.