The top authorities of U.S. cancer statistics will soon have to classify the sex of patients strictly as male, female, or unknown, a change scientists and advocates say will harm the health of transgender people, one of the nation’s most marginalized populations.

Scientists and advocates for trans rights say the change will make it much harder to understand cancer diagnoses and trends among the trans population. Certain studies have shown that transgender people are more likely to use tobacco products or less likely to receive routine cancer screenings — factors that could put them at higher risk of disease.

The change is a consequence of Trump administration policies recognizing only “male” and “female” sexes, according to cancer researchers.

Scientists said the change will affect all cancer registries, in every state and territory, because they receive federal funding. Starting in 2026, registries funded through the Centers for Disease Control and Prevention and the National Cancer Institute will categorize cancer patients as male, female, or not stated/unknown. And federal health agencies will receive data only on cancer patients classified that way.

Registries currently specify whether a cancer patient’s sex is “male,” “female,” “other,” various options for “transsexual,” or that the patient’s sex is not stated or unknown.

President Donald Trump in January issued an executive order stating that the government would recognize only male and female sexes. Cancer registry officials said the federal government directed them to revise how they collect data on cancer patients.

“In the U.S., if you’re receiving federal money, then we, essentially, we weren’t given any choice,” Eric Durbin, director of the Kentucky Cancer Registry and president of the North American Association of Central Cancer Registries, told KFF Health News. NAACCR, which receives federal funds, maintains cancer reporting standards across the U.S. and Canada.

Officials will need to classify patients’ sex as unknown when a “patient’s sex is documented as other than male or female (e.g., non-binary, transsexual), and there is no additional information about sex assigned at birth,” the new standard says.

Missing the Big Picture

Researchers said they do not have high-quality population-level data on cancer incidence in transgender people but had been making inroads at improving it — work now at risk of being undone.

“When it comes to cancer and inequities around cancer, you can use the cancer registries to see where the dirtiest air pollution is, because lung cancer rates are higher in those areas. You can see the impact of nuclear waste storage because of the types of cancers that are higher in those ZIP codes, in those areas of the country,” said Shannon Kozlovich, who is on the executive committee of the California Dialogue on Cancer.

“The more parts of our population that we are excluding from this dataset means that we are not going to know what’s happening,” she said. “And that doesn’t mean that it’s not happening.”

For decades, cancer registries have been the most comprehensive U.S. surveillance tool for understanding cancer incidence and survival rates and identifying troubling disease trends. Each year, cancer cases are reported by hospitals, pathology labs, and other health facilities into regional and statewide cancer registries. The compiled data documents cancer and mortality rates among regions, races, sexes, and age groups.

Two federal programs serve as the top authorities on cancer statistics, with information on tens of millions of cases. The CDC’s National Program of Cancer Registries provides funding to organizations in 46 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the U.S. Pacific Island territories. Its data represents 97% of the U.S. population. The National Cancer Institute’s Surveillance, Epidemiology, and End Results program, known as SEER, collects and publishes data from registries covering nearly half the U.S. population.

The information published by cancer registries has led to changes in treatment and  prevention, and the enactment of other policies designed to reduce diagnosis rates and mortality.

For example, data collected by cancer registries was essential in identifying rising rates of colorectal cancer among people younger than 50. As a result, U.S. guidelines now recommend that adults start screenings at age 45 rather than 50.

States have enacted their own measures. Lara Anton, spokesperson for the Texas Department of State Health Services, said epidemiologists with the Texas Cancer Registry in 2018 found that the state had the nation’s highest incidence rates of hepatocellular carcinoma, a liver cancer more common in men than women. The Cancer Prevention and Research Institute of Texas initiated a statewide effort aimed at reversing rising rates of liver cancer. The Texas Cancer Registry joined SEER in 2021.

“Once a cancer patient is entered into a cancer registry, we follow those patients for the rest of their lives. Because we really need to know, do patients survive for different types of cancer and different stages of cancer?” Durbin said. “That’s incredibly important for public policies.”

The North American Association of Central Cancer Registries maintains national standards outlining what kind of data registries collect for each diagnosis. It develops the list in partnership with the CDC, the National Cancer Institute, and other organizations.

For any given patient, under NAACCR’s standards, Durbin said, registries collect more than 700 pieces of information, including demographics, diagnosis, treatment, and length of survival. CDC and NCI-funded registries must specify the sex of each patient.

The NAACCR definitions and accompanying data standards are designed to ensure that registries collect case data uniformly. “Everyone essentially follows the standards” that NAACCR develops, Durbin said. Although registries can collect state-specific information, researchers said they need to follow those standards when sending cancer data to the federal government.

In an emailed statement, Department of Health and Human Services spokesperson Andrew Nixon said, “HHS is using biological science to guide policy, not ideological agendas that the Biden administration perpetrated.”

‘Backwards’ Progress

NAACCR routinely publishes updated guidelines. But the change to the “sex” category to remove transgender options in 2026 was an emergency move due to Trump administration policies, Kozlovich said. She was among a group that had pushed for changes in cancer data collection to account for sex and gender identity as separate data points.

According to an analysis of CDC data by the Williams Institute at the UCLA School of Law, 2.8 million people age 13 and older identify as transgender.

Scientists and trans rights advocates said in interviews that there are troubling signs that may make transgender people more likely to develop cancer or experience worse health outcomes than others.

“Without evidence of our health disparities, you take away any impetus to fix them,” said Scout, executive director of the LGBTQIA+ Cancer Network.

A study published in 2022 found that transgender and gender-diverse populations were two to three times as likely as cisgender people to report active use of cigarettes, e-cigarettes, or cigars. Tobacco use is a leading cause of cancer and death from cancer.

A Canadian study concluded in 2019 that transgender patients were less likely to receive recommended screenings for breast, cervical, and colorectal cancers. And a 2023 study from researchers at Stanford Medicine found that LGBTQ+ patients were nearly three times as likely to experience breast cancer recurrence as cisgender heterosexual people.

Scarlett Lin Gomez, an epidemiologist at the University of California-San Francisco and the director of the Greater Bay Area Cancer Registry, said that for at least 10 years the NCI had been interested in improving its ability to monitor cancer burden across patient populations with different sexual orientations and gender identities. Cancer registries are a logical place to start because that is what they’re set up to do, she said.

There’s been “slow but good progress,” Gomez said. “But now we’ve completely, personally, I think, regressed backwards.”

The decision not to capture transgender identity in cancer patients is just one change registries have confronted under the Trump administration, according to scientists leading surveillance efforts and state health agencies. An HHS mandate to reduce spending on contracts led to funding cuts for cancer registries in NCI’s SEER program. Scientists said CDC funds for registries haven’t been cut; however, the White House’s proposed fiscal 2026 budget aims to eliminate funding for the National Program of Cancer Registries.

Among the Trump administration’s other actions targeting trans people are canceling research grants for studies on LGBTQ+ health, dismantling the National Institutes of Health’s office for sexual and gender minority health, and stopping specialized services for LGBTQ+ youth on the 988 national suicide prevention hotline.

Without data, researchers can’t make a case to fund research that may help trans patients, Gomez said. “It’s erasure.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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WASHINGTON — The Food and Drug Administration is reversing a 2003 decision that put a stringent warning on hormone therapy products for menopausal women, saying that the treatments offer heart, brain, and bone health benefits. 

Commissioner Marty Makary wrote in a Wall Street Journal op-ed on Monday that the FDA is removing black box warning labels from all-combined estrogen-progestogen, estrogen-only, other estrogen-containing, and progestogen-only products used for hormone therapy. The agency said it’s asking companies to remove the warnings from their products, specifically mentions of cardiovascular, dementia, and breast cancer risk.

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Foreigners seeking visas to live in the U.S. might be rejected if they have certain medical conditions, including diabetes or obesity, under a Thursday directive from the Trump administration.

The guidance, issued in a cable the State Department sent to embassy and consular officials and examined by KFF Health News, directs visa officers to deem applicants ineligible to enter the U.S. for several new reasons, including age or the likelihood they might rely on public benefits. The guidance says that such people could become a “public charge” — a potential drain on U.S. resources — because of their health issues or age.

While assessing the health of potential immigrants has been part of the visa application process for years, including screening for communicable diseases like tuberculosis and obtaining vaccine history, experts said the new guidelines greatly expand the list of medical conditions to be considered and give visa officers more power to make decisions about immigration based on an applicant’s health status.

The directive is part of the Trump administration’s divisive and aggressive campaign to deport immigrants living without authorization in the U.S. and dissuade others from immigrating into the country. The White House’s crusade to push out immigrants has included daily mass arrests, bans on refugees from certain countries, and plans to severely restrict the total number permitted into the U.S.

The new guidelines mandate that immigrants’ health be a focus in the application process. The guidance applies to nearly all visa applicants but is likely to be used only in cases in which people seek to permanently reside in the U.S., said Charles Wheeler, a senior attorney for the Catholic Legal Immigration Network, a nonprofit legal aid group.

“You must consider an applicant’s health,” the cable reads. “Certain medical conditions – including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions – can require hundreds of thousands of dollars’ worth of care.”

About 10% of the world’s population has diabetes. Cardiovascular diseases are also common; they are the globe’s leading killer.

The cable also encourages visa officers to consider other conditions, like obesity, which it notes can cause asthma, sleep apnea, and high blood pressure, in their assessment of whether an immigrant could become a public charge and therefore should be denied entry into the U.S.

“All of these can require expensive, long-term care,” the cable reads. Spokespeople for the State Department did not immediately respond to a request for comment on the cable.

Visa officers were also directed to determine if applicants have the means to pay for medical treatment without help from the U.S. government.

“Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalization at government expense?” the cable reads.

The cable’s language appears at odds with the Foreign Affairs Manual, the State Department’s own handbook, which says that visa officers cannot reject an application based on “what if” scenarios, Wheeler said.

The guidance directs visa officers to develop “their own thoughts about what could lead to some sort of medical emergency or sort of medical costs in the future,” he said. “That’s troubling because they’re not medically trained, they have no experience in this area, and they shouldn’t be making projections based on their own personal knowledge or bias.”

The guidance also directs visa officers to consider the health of family members, including children or older parents.

“Do any of the dependents have disabilities, chronic medical conditions, or other special needs and require care such that the applicant cannot maintain employment?” the cable asks.

Immigrants already undergo a medical exam by a physician who’s been approved by a U.S. embassy.

They are screened for communicable diseases, like tuberculosis, and asked to fill out a form that asks them to disclose any history of drug or alcohol use, mental health conditions, or violence. They’re also required to have a number of vaccinations to guard against infectious diseases like measles, polio, and hepatitis B.

But the new guidance goes further, emphasizing that chronic diseases should be considered, said Sophia Genovese, an immigration lawyer at Georgetown University. She also noted that the language of the directive encourages visa officers and the doctors who examine people seeking to immigrate to speculate on the cost of applicants’ medical care and their ability to get employment in the U.S., considering their medical history.

“Taking into consideration one’s diabetic history or heart health history — that’s quite expansive,” Genovese said. “There is a degree of this assessment already, just not quite expansive as opining over, ‘What if someone goes into diabetic shock?’ If this change is going to happen immediately, that’s obviously going to cause a myriad of issues when people are going into their consular interviews.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Thinking of taking a trip abroad? Or maybe relocating for good? Americans would do well, even 150 years hence, to attend to Mark Twain’s satirical account of U.S. travelers journeying through Europe and Palestine, The Innocents Abroad. The “Americans who are painted to peculiar advantage by Mr. Clements” (sic), as fellow American satirist William Dean Howells wrote at the time, still roam the Earth—including travelers like one who “told the English officers that a couple of our gunboats could come and knock Gibraltar into the Mediterranean Sea.” The tactlessness and belligerence Twain skewered do not feel historically so far from home.

Twain’s portraits—“somewhat caricatured… or carefully and exactly done”—proved so popular with readers that he followed up with an unofficial sequel, 1880s A Tramp Abroad, a somewhat more serious fictionalized travelogue of Americans journeying through Europe; this time but two, Twain and his friend “Harris.” In the previous book, complained Howells, the reader learns “next to nothing about the population of the cities and the character of the rocks in the different localities.” Here, without his comedy troupe of traveling companions, Twain directs his focus outward with minute descriptions of his surroundings. He is, as usual, supremely curious, often perplexed, but mostly delighted by his experiences. Except when it comes to the food.

Growing “increasingly tired of an abundance of what he described as ‘fair-to-middling’ food,” writes Lists of Note, Twain comments: “The number of dishes is sufficient; but then it is such a monotonous variety of UNSTRIKING dishes […] Three or four months of this weary sameness will kill the robustest appetite.” Having never spent so long a time away, I cannot speak to Twain’s gustatory ennui, but I can relate, as no doubt can you, reader, to missing one or two familiar comfort foods (as well as “sincere and capable” ice water). Twain, perhaps not as adventurous an eater as he was a traveler—and in that sense also very much a modern American—made “an enormous list of the foods he’d missed the most, of which were to be consumed when he arrived home.”

The list, below, is itself a kind of travelogue, through the varieties of 19th century American cuisine, East, West, North, and South, including such delicacies as “’Possum” “Canvas-back-duck from Baltimore,” “Virginia bacon, broiled,” “Prairie hens, from Illinois,” and “Brook trout, from Sierra Nevadas.” While we might pine for a regional delicacy or favorite processed food, Twain conjured up in his mind’s gut a whole continent of food to come home to. What kinds of food do you find yourself missing when you travel? And how long a list might you find yourself making after several months tramping around in foreign lands? Tell us in the comments section below. For now, here’s Twain’s list:

Radishes. Baked apples, with cream
Fried oysters; stewed oysters. Frogs.
American coffee, with real cream.
American butter.
Fried chicken, Southern style.
Porter-house steak.
Saratoga potatoes.
Broiled chicken, American style.
Hot biscuits, Southern style.
Hot wheat-bread, Southern style.
Hot buckwheat cakes.
American toast. Clear maple syrup.
Virginia bacon, broiled.
Blue points, on the half shell.
Cherry-stone clams.
San Francisco mussels, steamed.
Oyster soup. Clam Soup.
Philadelphia Terapin soup.
Oysters roasted in shell-Northern style.
Soft-shell crabs. Connecticut shad.
Baltimore perch.
Brook trout, from Sierra Nevadas.
Lake trout, from Tahoe.
Sheep-head and croakers, from New Orleans.
Black bass from the Mississippi.
American roast beef.
Roast turkey, Thanksgiving style.
Cranberry sauce. Celery.
Roast wild turkey. Woodcock.
Canvas-back-duck, from Baltimore.
Prairie hens, from Illinois.
Missouri partridges, broiled.
‘Possum. Coon.
Boston bacon and beans.
Bacon and greens, Southern style.
Hominy. Boiled onions. Turnips.
Pumpkin. Squash. Asparagus.
Butter beans. Sweet potatoes.
Lettuce. Succotash. String beans.
Mashed potatoes. Catsup.
Boiled potatoes, in their skins.
New potatoes, minus the skins.
Early rose potatoes, roasted in the ashes, Southern style, served hot.
Sliced tomatoes, with sugar or vinegar. Stewed tomatoes.
Green corn, cut from the ear and served with butter and pepper.
Green corn, on the ear.
Hot corn-pone, with chitlings, Southern style.
Hot hoe-cake, Southern style.
Hot egg-bread, Southern style.
Hot light-bread, Southern style.
Buttermilk. Iced sweet milk.
Apple dumplings, with real cream.
Apple pie. Apple fritters.
Apple puffs, Southern style.
Peach cobbler, Southern style
Peach pie. American mince pie.
Pumpkin pie. Squash pie.
All sorts of American pastry.
Fresh American fruits of all sorts, including strawberries which are not to be doled out as if they were jewelry, but in a more liberal way. 
Ice-water—not prepared in the ineffectual goblet, but in the sincere and capable refrigerator.

Note: An earlier version of this post appeared on our site in 2016.

Related Content:

Explore an Online Archive of 12,700 Vintage Cookbooks

The Only Footage of Mark Twain: The Original & Digitally Restored Films Shot by Thomas Edison

Mark Twain Drafts the Ultimate Letter of Complaint (1905)

Mark Twain Creates a List of His Favorite Books For Adults & Kids (1887)

Josh Jones is a writer and musician based in Durham, NC. 

Right after college, I moved to San Francisco, a city where I knew one person. I had a lonely time at first, and in particular I struggled to stay connected to the friends I no longer shared a campus with. I wasn’t very good at calling people on the phone and my email correspondences were sporadic at best. But what I did have was my Reader Crew, a group of friends who were all devoted to Google Reader.

Some of you have already lit up at the mention of Google Reader—it’s got a devoted following of mourners. Reader was a short-lived aggregator of RSS feeds (RSS stands for “Really Simple Syndication”). Sites can publish RSS feeds which allow you to access that sites content in another program, called a reader, where you can scroll, sort, and search. These readers pull together any feeds you curate, keeping them updated and tracked. RSS feeds tend to be the posts and articles from a site—scroll down to the bottom of this page and you can see ours—but most RSS readers can also handle newsletters, Tumblrs, and even specific Google searches can rendered in RSS.

Google’s Reader was special because it had some very light social aspects: you were able to follow other people, who could share things from their own feeds into your feed, with or without a small bit of commentary. You could comment on or “like” these shares, but that was about it. There was no big public feed of everyone’s stuff, there was no push to discover other users, and there was no way to make content for Reader. It was just curation and light commentary, if you wanted it.

Molly White wrote a great piece recently for her newsletter that describes RSS aggregation as “curating your own newspaper,” and this was my Reader Crew’s experience. My feed felt like a magazine I was editing, with a small group of friends popping in to guest edit every now and then. It was small, pleasant, and slow.

We were pretty bereft when Google killed Reader, as were many other devotees. It’s hard to replace. Reader was similar to social media, where you can also curate what you’re reading, but without the massive public news feeds and the jockeying for attention. Reader’s more intimate size also felt a bit like a group chat, maybe, but less chaotic and ever-present.

Thankfully, we discovered The Old Reader, which aims to recreate the Google-axed experience and does it admirably well. If you miss Reader, it’s worth a look. But if you’re just starting out with RSS, don’t stress too much about which program to use. There are a lot of free and cheap options that others have aggregated—like Molly White’s from above. Really the question comes down to interface: what is pleasant for you to use and look at? But it’s easy to import and export your list of feeds, so you can always bop around if you want.

I really recommend giving RSS a try, especially if you’re tired of endless feeds that feel like constant, multidirectional fire hoses. I love RSS primarily because you can curate who and what you want to hear from. The pacing is self directed too, and never overwhelming. It feels like riding a bike: fast enough to get somewhere, but slow that the ride is enjoyable. And like reading, you control the frame rate, and can stop, slow down, or go back in your feed if you need to. Which is unlike the stationary bike of social media, where some red-pilled millionaire engineer is cranking a dial to make you peddle faster. Plus, you can get to the end of your RSS feeds, unlike a social scroll which is endless by design.

This scale and pacing issue seems to be part of why RSS never caught on with Silicon Valley business types. It’s a tech that was never flashy or engaging enough. David Pierce wrote an interesting deep dive for The Verge called “Who killed Google Reader?” that reveals how executives never got what was so special about Reader, and had it out for the product from the start. They saw it as “a humble feed aggregator built on boring technology” and “in meeting after meeting, they’d ask why Reader wasn’t just a tab in the Gmail app.”

It’s another reason to love RSS: seems like the tech lords hate it.

When you’re a businessman making dollar-sign eyes at things like Twitter and Facebook, you’re certainly going to be less horny about a product that is slower and less addicting. RSS lacks a stickiness that keeps you compelled to go back. It’s much closer to a tool, allowing you to create something unique and private, that is only as useful or enjoyable as you make it.

We need a new word other than “feed” to describe RSS. A “feed” is for molten metals extruded along an assembly line, or for bullets pumped into a machine gun. Maybe we should start calling the aggregation of RSS feeds “fields” or “pastures”: contained spaces where you can plant and harvest as you like, with no one butting in unless they’re invited.