Analysis of 20,764 White and 882 Black bladder cancer patients diagnosed during 1978-85 indicates that Black patients were more likely than White patients to go untreated following diagnosis after adjustment for age- and stage-at-diagnosis, sex, and tumor histology (OR = 1.80, 95% CI = 1.33, 2.43). Treatment status was found to be a significant predictor of five-year survival after adjustment (treated/untreated odds ratio = 3.16, 95% CI = 2.08, 4.79). Results suggest that differences in initial therapy may contribute to the survival differential between Black and White bladder cancer patients.