US Cancer Registries to Adopt Binary Sex Classification, Sparking Widespread Concern

Beginning in 2026, U.S. cancer registries will be mandated to classify patient sex strictly as "male," "female," or "unknown," a significant policy shift stemming from the Trump administration. This directive, impacting all federally funded registries, has raised alarms among scientists and transgender rights advocates, as reported by KFF Health News on November 21, 2025.

Experts warn that this change will severely impede the understanding of cancer diagnoses and trends within the transgender population. The inability to collect granular data on gender identity could obscure critical health disparities, making it harder to implement targeted prevention and treatment strategies for this marginalized group, according to the article.

The policy originates from a January executive order by President Donald Trump, which stated that the government would recognize only "male" and "female" sexes. Cancer registry officials confirmed they were directed by the federal government to revise their data collection methods to comply with this order, as KFF Health News reported.

Currently, many registries allow for more inclusive categories, such as "other" or various options for "transsexual," alongside "male" and "female." The upcoming mandate will eliminate these options, forcing a binary classification that does not reflect the diversity of gender identities, according to news-medical.net.

This move is seen by many as a step backward, particularly after years of efforts to improve data collection on sexual orientation and gender identity (SOGI) in healthcare. The Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) will only receive data categorized under the new binary system starting in 2026.

Eric Durbin, director of the Kentucky Cancer Registry and president of the North American Association of Central Cancer Registries (NAACCR), told KFF Health News that registries receiving federal funds "weren't given any choice" in the matter. This highlights the top-down nature of the policy implementation.

Advocates for transgender rights and public health scientists are united in their concern, emphasizing that accurate data is fundamental to addressing health inequities. Scout, executive director of the LGBTQIA+ Cancer Network, stated that "Without evidence of our health disparities, you take away any impetus to fix them," as noted by KFF Health News.

• The policy change represents a significant reversal of previous efforts to enhance the collection of sexual orientation and gender identity (SOGI) data in healthcare. For instance, in 2011, the U.S. Department of Health and Human Services (HHS) under Secretary Kathleen Sibelius announced plans to collect such data to identify and reduce health disparities among LGBT populations, integrating questions into surveys like the National Health Interview Survey, as detailed by NIH.

• Scientists and advocates have consistently highlighted the importance of distinguishing between sex assigned at birth and gender identity for comprehensive health research. A 2022 report emphasized a two-step protocol for gender identity collection: asking about sex on the birth certificate and then current gender identity, to ensure accurate data for transgender individuals, according to asbmb Today.

• The lack of inclusive data collection has direct implications for understanding specific cancer risks and outcomes within the transgender community. Studies have indicated that transgender individuals may face higher rates of certain risk factors, such as tobacco use, and are less likely to receive routine cancer screenings, including for breast and cervical cancers, as reported by gavi, the Vaccine Alliance in March 2023.

• This binary classification policy is part of a broader pattern of actions by the Trump administration impacting LGBTQ+ health data and resources. In January 2025, public health data related to LGBTQ+ individuals disappeared from federal websites, and agencies were directed to strip "gender ideology" from various documents and programs, according to reports from January 2025.

• The scientific community has long called for improved SOGI data collection in cancer registries to better understand cancer burden and disparities. An epidemiologist at the University of California-San Francisco and director of the Greater Bay Area Cancer Registry, Scarlett Lin Gomez, noted that the NCI had been interested in improving its ability to monitor cancer across diverse patient populations for at least a decade, as cited by KFF Health News.

• The potential impact extends beyond data collection to research funding and the ability to advocate for specific health needs. Without robust data, researchers struggle to make a compelling case for funding studies that could directly benefit transgender patients, a situation described as "erasure" by Gomez in KFF Health News.

• Concerns about the proposed budget for Fiscal Year 2026 also loom, with a 26.2% cut to the Department of Health and Human Services, including a 37% cut to the National Institutes of Health and the elimination of the National Center for Chronic Disease Prevention and Health Promotion at the CDC. The American Cancer Society Cancer Action Network (ACS CAN) warned in May 2025 that these cuts pose a major threat to cancer research and prevention.

• The policy's enforcement through federal funding mechanisms means that all state and territorial cancer registries, regardless of their local practices, must adhere to the binary classification to receive federal support. This centralized control over data standards effectively homogenizes data in a way that obscures diversity, as confirmed by Eric Durbin of NAACCR to KFF Health News.