Routinely collected health data (RCHD) from administrative claims, electronic medical records, disease registries, and other sources transform the way in which knowledge about cancer is generated. Created and collected as part of routine oncological practice, these data capture cancer-related care provided to real-world patients in real-world settings. As with other types of realworld data, including data generated by patients through websites and wearable devices, measures of social determinants of health, and environmental exposures, RCHD are increasingly popular among researchers, funders, and policy makers because of the potential to generate actionable evidence. The availability of RCHD at low or no cost for large patient populations with long followed-up periods and almost real-time updates has attracted numerous researchers pursuing a nearly infinite number of research questions using any particular set of RCHD.The overarching goal of RCHD is to improve care and outcomes for patients with cancer, a goal that can only be achieved when analyses provide valid inferences. For years, central to the validity of RCHD studies were issues related to data quality (eg, the ability of RCHD to accurately capture clinical information) and biases originating from the observational nonrandomized nature of these studies (eg, confounding). Thankfully, with advances in informatics and causal inference, there is now an array of approaches to overcome the caveats. However, 2 other distinct properties of RCHD have received little attention despite their potential to undermine the validity of inferences: (1) the use of RCHD for formulating research hypotheses that are then examined with the same data (selective inference), and (2) the pursuing of numerous research questions within the same database (multiple testing).In this Viewpoint, we discuss how biases originating from selective inference and multiple testing can potentially invalidate conclusions from RCHD studies, even when high-quality data are analyzed with state-ofthe-art causal inference methodologies.