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A 27-year-old Hispanic man presents to an emergency department in New Jersey in August 2014 after seeing blood in his urine earlier that day. He tells clinicians that although he has no trouble urinating, he has had vague abdominal pain for the past 4 months.
When answering questions about his medical history, the patient notes that he was born in Peru and that his father had colon cancer. The patient is not a smoker, drinks alcohol only occasionally at social events, and has been working at UPS for the past few years; his job involves loading trucks, but he is not aware of any chemical exposure.