This chapter examines the impact of the 2020 US Census policy changes on age-adjusted cancer mortality rates among American Indian and Alaska Native (AIAN) populations in Oklahoma. Historically, the US Census used “bridged” population estimates to align multiracial respondents with pre-2000 racial categories. With the 2020 Census, this approach was discontinued, shifting to a six-race classification, significantly affecting AIAN population estimates. Given that AIAN populations have some of the highest documented cancer mortality rates, particularly in the Southern Plains, Northern Plains, and Alaska, this change raises concerns about the accuracy of cancer burden assessments. This chapter analyzes Oklahoma’s AIAN cancer mortality trends using Oklahoma Vital Statistics and the OK2SHARE public health database. By comparing mortality rates under the four-race bridged and six-race estimates, the study highlights change not due to screening or healthcare access but to revised population denominators. Findings show a statistically significant decrease in AIAN cancer mortality rates under the six-race system, likely due to shifts in racial categorization. The results highlight the sociopolitical nature of racial classification and its implications for the interpretation of public health data. This chapter aims to inform non-epidemiologists, including policymakers and journalists, about the complexities of racial data reporting and its real-world consequences.