Age at exposure modifies the effects of low-level ionizing radiation on cancer mortality in an occupational cohort

In a cohort of 4,563 nuclear workers followed retrospectively from 1950 to 1994, we found that age at exposure modified the effects of external radiation dose on cancer mortality. Analyses involved application of conditional logistic regression to risk sets of age- and calendar time-matched cancer deaths, with covariates treated as time dependent and with cumulative radiation doses divided according to the age intervals in which exposure occurred. After adjustment for confounding factors, we found that workers exposed to external radiation after the age of 50 years experienced exposure-related elevations in mortality from cancer at any site [rate ratio (RR) = 1.98; 95% confidence interval (CI) = 0.63-6.26], radiosensitive solid cancer (RR = 3.29; 95% CI = 1.10-9.89), and lung cancer (RR = 3.89; 95% CI = 1.23-12.3) substantially greater (1.6- to 3.5-fold greater) than were seen in coworkers exposed at all earlier ages. In contrast, all of the radiation doses contributing to mortality from cancers of the blood and lymph system were received before age 50 (for age <50, RR = 2.73 and 95% CI = 1.46-5.10; for age > or =50, RR = 0.24 and 95% CI = 0.00-687). Our results for cancer of any site are consistent with the results of previous studies examining the effects of exposure age in nuclear workers. Thus, effects of low-level radiation doses may depend on exposure age, and furthermore, patterns of effect modification by age may differ by type of cancer.     

Fonofos exposure and cancer incidence in the agricultural health study

BACKGROUND: The Agricultural Health Study (AHS) is a prospective cohort study of licensed pesticide applicators from Iowa and North Carolina enrolled 1993-1997 and followed for incident cancer through 2002. A previous investigation in this cohort linked exposure to the organophosphate fonofos with incident prostate cancer in subjects with family history of prostate cancer. OBJECTIVES: This finding along with findings of associations between organophosphate pesticides and cancer more broadly led to this study of fonofos and risk of any cancers among 45,372 pesticide applicators enrolled in the AHS. METHODS: Pesticide exposure and other data were collected using self-administered questionnaires. Poisson regression was used to calculate rate ratios (RRs) and 95% confidence intervals (CIs) while controlling for potential confounders. RESULTS: Relative to the unexposed, leukemia risk was elevated in the highest category of lifetime (RR = 2.24; 95% CI, 0.94-5.34, Ptrend = 0.07) and intensity-weighted exposure-days (RR = 2.67; 95% CI, 1.06-6.70, Ptrend = 0.04), a measure that takes into account factors that modify pesticide exposure. Although prostate cancer risk was unrelated to fonofos use overall, among applicators with a family history of prostate cancer, we observed a significant dose-response trend for lifetime exposure-days (Ptrend = 0.02, RR highest tertile vs. unexposed = 1.77, 95% CI, 1.03-3.05; RRinteraction = 1.28, 95% CI, 1.07-1.54). Intensity-weighted results were similar. No associations were observed with other examined cancer sites. CONCLUSIONS: Further study is warranted to confirm findings with respect to leukemia and determine whether genetic susceptibility modifies prostate cancer risk from pesticide exposure.     

Mortality from ischemic heart disease and diabetes mellitus (type 2) in four U.S. wheat-producing states: a hypothesis-generating study

In this ecologic study I examined ischemic heart disease (IHD) and diabetes mortality in rural agricultural counties of Minnesota, Montana, North Dakota, and South Dakota, in association with environmental exposure to chlorophenoxy herbicides, using wheat acreage as a surrogate exposure. I collected data on agricultural land use and 1979-1998 mortality from the U.S. Department of Agriculture and the Centers for Disease Control and Prevention websites, respectively. Counties were grouped based on percentage of land area dedicated to wheat farming. Poisson relative risks (RR) and 95% confidence intervals (CIs), comparing high- and medium- with low-wheat counties, were obtained for IHD, the subcategories acute myocardial infarction (AMI) and coronary atherosclerosis (CAS), and diabetes, adjusting for sex, age, mortality cohort, and poverty index. Mortality from IHD was modestly increased (RR = 1.08; 95% CI, 1.04-1.12). Analyses of its two major forms were more revealing. Compared with low-wheat counties, mortality in high-wheat counties from AMI increased (RR = 1.20; 95% CI, 1.14-1.26), and mortality from CAS decreased (RR = 0.89; 95% CI, 0.83-0.96). Mortality from AMI was more pronounced for those < 65 years of age (RR = 1.31; 95% CI 1.22-1.39). Mortality from type 2 diabetes increased (RR = 1.16; 95% CI, 1.08-1.24). These results suggest that the underlying cause of mortality from AMI and type 2 diabetes increased and the underlying cause of mortality from CAS decreased in counties where a large proportion of the land area is dedicated to spring and durum wheat farming. Firm conclusions on causal inference cannot be reached until more definitive studies have been conducted.     

Temporal variation in the association between benzene and leukemia mortality

BACKGROUND: Benzene is a human carcinogen. Exposure to benzene occurs in occupational and environmental settings. OBJECTIVE: I evaluated variation in benzene-related leukemia with age at exposure and time since exposure. METHODS: I evaluated data from a cohort of 1,845 rubber hydrochloride workers. Benzene exposure-leukemia mortality trends were estimated by applying proportional hazards regression methods. Temporal variation in the impact of benzene on leukemia rates was assessed via exposure time windows and fitting of a multistage cancer model. RESULTS: The association between leukemia mortality and benzene exposures was of greatest magnitude in the 10 years immediately after exposure [relative rate (RR) at 10 ppm-years = 1.19; 95% confidence interval (CI), 1.10-1.29]; the association was of smaller magnitude in the period 10 to < 20 years after exposure (RR at 10 ppm-years = 1.05; 95% CI, 0.97-1.13); and there was no evidence of association > or = 20 years after exposure. Leukemia was more strongly associated with benzene exposures accrued at > or = 45 years of age (RR at 10 ppm-years = 1.11; 95% CI, 1.04-1.17) than with exposures accrued at younger ages (RR at 10 ppm-years = 1.01; 95% CI, 0.92-1.09). Jointly, these temporal effects can be efficiently modeled as a multistage process in which benzene exposure affects the penultimate stage in disease induction. CONCLUSIONS: Further attention should be given to evaluating the susceptibility of older workers to benzene-induced leukemia.     

Population exposures to I-131 releases from Hanford Nuclear Reservation and preterm birth,infant mortality,and fetal deaths

Communities surrounding the Hanford Nuclear Reservation in southeastern Washington were exposed to radionuclides, particularly iodine-131, released during the period 1945 to 1951. This study evaluated whether estimated iodine-131 exposures were risk factors for infant mortality, fetal death, and preterm birth in the years of highest releases, 1945 and 1946. Data on births, fetal deaths, and infant deaths, during the period 1940 to 1950, were abstracted from vital records for an eight county area surrounding the Hanford facility. The analysis included 56,320 births, 1,656 infant deaths, and 806 fetal deaths. The Hanford Environmental Dose Reconstruction project provided iodine-131 dose estimates for the 1,102 grid areas in the study area. The grid areas were collapsed into 4 exposure groups using estimated exposure to iodine-131 during 1945. Each birth and death record was assigned to one of the four grid groups based on mother's residence at the time of birth. Comparisons of preterm birth, infant death, and fetal death rates were made among the grid groupings for the primary exposure period (1945 to 1946) and for other years of the study period (i.e., 1940 to 1944 and 1947 to 1950). In the grid group with the highest estimated iodine-131 exposures, the mother's residence during the latter part of pregnancy was associated with preterm birth (OR = 1.74, 95% CI = 1.09-2.72). An association with infant mortality (OR = 1.26, 95% CI = 0.79-1.97) was suggested. No association was found for fetal deaths. This study found that iodine-131 exposure was associated with increased risk of preterm birth. This finding is biologically plausible because other studies have found that: (1) iodine-131 exposure can cause hypothyroidism, and (2) overt or subclinical hypothyroidism during pregnancy can increase a mother's risk of a preterm delivery.     

Mortality patterns among workers exposed to styrene in the reinforced plastic boatbuilding industry: an update

BACKGROUND: Mortality was updated through 1998 for 5,204 workers exposed to styrene between 1959 and 1978 at two reinforced plastic boatbuilding plants. The a priori hypothesis: leukemia and lymphoma excesses would be found. METHODS: Standardized mortality ratios (SMR) and 95% confidence intervals (CI) used Washington State and U.S. rates. RESULTS: Overall, 860 deaths occurred (SMR 1.09, CI 1.02-1.17), with excess mortality for esophageal cancer (n = 12, SMR 2.30, CI 1.19-4.02), prostate cancer (n = 24, SMR 1.71, CI 1.09-2.54), and accidents (n = 99, SMR 1.26, CI 1.02-1.53). Among 2,062 highly exposed workers, urinary tract cancer (n = 6, SMR 3.44, CI 1.26-7.50) and respiratory disease (n = 12, SMR 2.54, CI 1.31-4.44) rates were elevated. Urinary tract cancer SMR increased with duration of employment. CONCLUSIONS: We found no excess leukemia or lymphoma mortality. Unanticipated excess urinary tract cancer and respiratory disease mortality, possibly associated with styrene exposure, are difficult to interpret and could be chance findings.     

Occupational sunlight exposure and cancer incidence among Swedish construction workers

We studied sunlight exposure from outdoor work in relation to cancer, using data from 323,860 men participating in an occupational health service program of the Swedish construction industry. An experienced industrial hygienist assessed the exposure for 200 job tasks. We estimated relative risks (RRs) adjusted for age, smoking, and magnetic field exposure. There was an increased RR in the high-exposure group for myeloid leukemia [RR = 2.0, 95% confidence interval (95% CI) = 1.1-3.6] and lymphocytic leukemia (RR = 1.7, 95% CI = 0.9-3.2). For non-Hodgkin's lymphoma there was a 30% increase in risk in the high-exposure group (95% CI = 0.9-1.9). There was no increased risk of malignant melanoma, except for tumors of the head, face, and neck in the high-exposure group (RR = 2.0, 95% CI = 0.8-5.2), and we also found an increased risk for malignant melanoma of the eye in this group (RR = 3.4, 95% CI = 1.1-10.5). Outdoor workers had no increased risk of nonmelanoma skin cancer. Nevertheless, the RR for lip cancer (squamous cell carcinoma) among the high-exposure group was estimated at 1.8 (95% CI = 0.8-3.7). Among other sites, an increased risk of stomach cancer was suggested in this group (RR = 1.4, 95% CI = 1.0-1.9). The results for lymphoma, leukemia, and possibly also for stomach cancer might reflect a suppression of the immune system from ultraviolet light in outdoor workers.     

Dairy products, dietary calcium and vitamin D intake as risk factors for prostate cancer: a meta-analysis of 26,769 cases from 45 observational studies

In this study, we examined the available evidence and sources of heterogeneity for studies of dairy products, calcium, and vitamin D intake and the risk of prostate cancer. We pooled data from 45 observational studies using a general variance-based, meta-analytic method employing CIs. Summary relative risks (RRs) were calculated for specific dairy products such as milk and dairy micronutrients. Sensitivity analyses were performed to test the robustness of these summary measures of effect. Cohort studies showed no evidence of an association between dairy [RR = 1.06; 95% confidence interval (CI) = 0.92-1.22] or milk intake (RR = 1.06; 95% CI = 0.91-1.23) and risk of prostate cancer. This was supported by pooled results of case-control analyses (RR = 1.14; 95% CI = 1.00-1.29), although studies using milk as the exposure of interest were heterogeneous and could not be combined. Calcium data from cohort studies were heterogeneous. Case-control analyses using calcium as the exposure of interest demonstrated no association with increased risk of prostate cancer (RR = 1.04; 95% CI = 0.90-1.15). Dietary intake of vitamin D also was not related to prostate cancer risk (RR = 1.16; 95% CI = 0.98-1.38). The data from observational studies do not support an association between dairy product use and an increased risk of prostate cancer.     

Efficacy of Antioxidant Vitamins and Selenium Supplement in Prostate Cancer Prevention: A Meta-Analysis of Randomized Controlled Trials

Several studies have evaluated the possible association between antioxidants vitamins or selenium supplement and the risk of prostate cancer, but the evidence is still inconsistent.

We systematically searched PubMed, EMBASE, the Cochrane Library, Science Citation Index Expanded, Chinese biomedicine literature database, and bibliographies of retrieved articles up to January 2009. We included 9 randomized controlled trials with 165,056 participants; methodological quality of included trials was generally high. Meta-analysis showed that no significant effects of supplementation with β-carotene (RR 0.97, 95% CI 0.90–1.05) (3 trials), vitamin C (RR 0.98, 95% CI 0.91–1.06) (2 trials), vitamin E (RR 0.96, 95% CI 0.85–1.08) (5 trials), and selenium (RR 0.78, 95% CI 0.41–1.48) (2 trials)versus placebo on prostate cancer incidence. The mortality of prostate cancer did not differ significantly by supplement of β-carotene (RR 1.19, 95% CI 0.87 -1.65) (1 trial), vitamin C (RR 1.45, 95%CI 0.92–2.29) (1 trial), vitamin E (RR 0.85, 95%CI 0.58–1.24) (2 trials), and selenium (RR 2.98, 95% CI 0.12–73.16) (1 trial). Our findings indicate that antioxidant vitamins and selenium supplement did not reduce the incidence and mortality of prostate cancer, these data provide no support for the use of these supplements for the prevention of prostate cancer.     

Diet Quality as Assessed by the Healthy Eating Index,Alternate Healthy Eating Index,Dietary Approaches to Stop Hypertension Score,and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies

Background

Diets of the highest quality have been associated with a significantly lower risk of noncommunicable diseases.

Association of alcohol-related laws with deaths due to motor vehicle and motorcycle crashes in the United States, 1980-1997

The authors compared US motor vehicle and motorcycle mortality rates during periods when each of several alcohol-related laws were in effect with mortality rates during other periods. During the period 1980-1997, there were 792,184 deaths due to motor vehicle crashes and 63,052 deaths due to motorcycle crashes. An estimated 26% and 49% of these fatalities, respectively, were attributable to alcohol use. The incidence of alcohol-related mortality in motor vehicle crashes was lower when laws specifying a blood alcohol concentration of 0.08 g/dl per se (laws stating that it is a criminal offense to drive with a blood alcohol concentration above the state's legal limit) were in effect (adjusted rate ratio (RR) = 0.86, 95% confidence interval (CI): 0.83, 0.88). For motorcycle deaths, the adjusted rate ratio was 0.87 (95% CI: 0.79, 0.95). The incidence of alcohol-related mortality in motor vehicle crashes was also lower during periods when two other types of laws were in effect: zero tolerance laws (adjusted RR = 0.88, 95% CI: 0.86, 0.90) and administrative license revocation laws (adjusted RR = 0.95, 95% CI: 0.93, 0.98). Overall motorcycle mortality was lower when administrative license revocation laws were in effect (adjusted RR = 0.95, 95% CI: 0.92, 0.98).     

Cancer mortality among northern Georgia carpet and textile workers

Proportionate cancer mortality was analyzed among white male carpet and textile workers in five northwest Georgia counties for the years 1970-1984. Compared with other Georgians, carpet and textile workers had higher proportions of lymphocytic leukemia (proportionate cancer mortality ratio [PCMR] = 2.9; 95% CI = 1.4-5.4]) and testicular cancer (PCMR = 3.2; 95% CI = 1.0-7.5). The excess mortality from lymphocytic leukemia was even higher when the analysis was limited to workers deemed most likely to work directly in production areas (PCMR = 4.2; 95% CI = 1.7-8.7). Further studies are needed to determine if the observed excesses are the result of workplace exposures.     

Health effects of dioxin exposure: a 20-year mortality study

Follow-up of the population exposed to dioxin after the 1976 accident in Seveso, Italy, was extended to 1996. During the entire observation period, all-cause and all-cancer mortality did not increase. Fifteen years after the accident, mortality among men in high-exposure zones A (804 inhabitants) and B (5,941 inhabitants) increased from all cancers (rate ratio (RR) = 1.3, 95% confidence interval (CI): 1.0, 1.7), rectal cancer (RR = 2.4, 95% CI: 1.2, 4.6), and lung cancer (RR = 1.3, 95% CI: 1.0, 1.7), with no latency-related pattern for rectal or lung cancer. An excess of lymphohemopoietic neoplasms was found in both genders (RR = 1.7, 95% CI: 1.2, 2.5). Hodgkin's disease risk was elevated in the first 10-year observation period (RR = 4.9, 95% CI: 1.5, 16.4), whereas the highest increase for non-Hodgkin's lymphoma (RR = 2.8, 95% CI: 1.1, 7.0) and myeloid leukemia (RR = 3.8, 95% CI: 1.2, 12.5) occurred after 15 years. No soft tissue sarcoma cases were found in these zones (0.8 expected). An overall increase in diabetes was reported, notably among women (RR = 2.4, 95% CI: 1.2, 4.6). Chronic circulatory and respiratory diseases were moderately increased, suggesting a link with accident-related stressors and chemical exposure. Results support evaluation of dioxin as carcinogenic to humans and corroborate the hypotheses of its association with other health outcomes, including cardiovascular- and endocrine-related effects.     

Radiation exposure and cancer mortality in uranium processing workers.

Data from the Comprehensive Epidemiology Data Resource (CEDR) allowed me to study patterns of cancer mortality in a cohort of 4,014 uranium-processing workers. Employing risk-set analysis for cohort data, I estimated the effects of external (gamma) and internal (alpha) radiation on cancer mortality. My results indicate that Fernald workers exposed to ionizing radiation experienced an increase in mortality from total cancer (per 100 mSv external dose rate ratio (RR) = 1.92; 95% confidence interval (CI) = 1.11-3.32), radiosensitive solid cancer (RR = 2.00; 95% CI = 1.02-3.94), and lung cancer (RR = 2.77; 95% CI = 1.29-5.95). Effects were strongest when exposure had occurred at older ages (>40 years). In addition, I observed an increase in lung-cancer mortality for workers exposed to > or =200 mSv of internal (alpha) radiation (RR = 1.92; 95% CI = 0.53-6.96). Furthermore, my results demonstrate the importance of a long follow-up time when studying solid cancers, the potential for bias due to worker selection associated with concomitant chemical exposures, problems of exposure measurement, confounding, and effect modification due to age at exposure. Owing to lack of data, a previous pooled analysis of uranium-processing workers could only partially address these issues.     

Effects of health insurance and race on colorectal cancer treatments and outcomes

OBJECTIVES: We hypothesized that health insurance payer and race might influence the care and outcomes of patients with colorectal cancer. METHODS: We examined treatments received for all incident cases of colorectal cancer occurring in Florida in 1994 (n = 9551), using state tumor registry data. We also estimated the adjusted risk of death (through 1997), using proportional hazards regression analysis controlling for other predictors of mortality. RESULTS: Treatments received by patients varied considerably according to their insurance payer. Among non-Medicare patients, those in the following groups had higher adjusted risks of death relative to commercial fee-for-service insurance: commercial HMO (risk ratio [RR] = 1.40; 95% confidence interval [CI] = 1.18, 1.67; P = .0001), Medicaid (RR = 1.44; 95% CI = 1.06, 1.97; P = .02), and uninsured (RR = 1.41; 95% CI = 1.12, 1.77; P = .003). Non-Hispanic African Americans had higher mortality rates (RR = 1.18; 95% CI = 1.01, 1.37; P = .04) than non-Hispanic Whites. CONCLUSIONS: Patients with colorectal cancer who were uninsured or insured by Medicaid or commercial HMOs had higher mortality rates than patients with commercial fee-for-service insurance. Mortality was also higher among non-Hispanic African American patients.     

Cancer mortality among US men and women with asthma and hay fever

The relation between self-reported physician-diagnosed asthma and/or hay fever and cancer mortality was explored in a prospective cohort study of 1,102,247 US men and women who were cancer-free at baseline. During 18 years of follow-up, from 1982 to 2000, there were 81,114 cancer deaths. Cox proportional hazards models were used to obtain adjusted relative risks for all cancer mortality and for cancer mortality at 12 sites associated with allergy indicators. There were significant inverse associations between a history of both asthma and hay fever and overall cancer mortality (relative risk (RR) = 0.88, 95% confidence interval (CI): 0.83, 0.93) and colorectal cancer mortality (RR = 0.76, 95% CI: 0.64, 0.91) in comparison with persons with neither of these allergic conditions. A history of hay fever only was associated with a significantly lowered risk of pancreatic cancer mortality, and a history of asthma only was associated with a significantly lowered risk of leukemia mortality. In never smokers, these associations persisted but were no longer significant. Results for mortality from cancer at other sites were less consistent. Collectively, these results suggest an inverse association between a history of allergy and cancer mortality; however, the strength of evidence for this association is limited.     

Predictors of accidental fatal drug overdose among a cohort of injection drug users

OBJECTIVES: This study evaluated factors associated with accidental fatal drug overdose among a cohort of injection drug users (IDUs). METHODS: In a prospective cohort study of 2849 IDUs in King County, Washington, deaths were identified by electronically merging subject identifiers with death certificate records. Univariate and multivariate Cox regression analyses were performed to identify predictors of overdose mortality. RESULTS: Thirty-two overdoses were observed. Independent predictors of overdose mortality were bisexual sexual orientation (relative risk [RR] = 4.86; 95% confidence interval [CI] = 2.30, 13.2), homelessness (RR = 2.30; 95% CI = 1.06, 5.01), infrequent injection of speedballs (RR = 5.36; 95% CI = 1.58, 18.1), daily use of powdered cocaine (RR = 4.84; 95% CI = 1.13, 20.8), and daily use of poppers (RR = 22.0; 95% CI = 1.74, 278). CONCLUSIONS: Sexual orientation, homelessness, and drug use identify IDUs who may benefit from targeted interventions.     

Cancer Incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia

CONTEXT: Composed of all or a portion of 13 states, Appalachia is a heterogeneous, economically disadvantaged region of the eastern United States. While mortality from cancer in Appalachia has previously been reported to be elevated, rates of cancer incidence in Appalachia remain unreported. PURPOSE: To estimate Appalachian cancer incidence by stage and site and to determine if incidence was greater than that in the United States. METHODS: Using 1994--1998 data from the central registries of Kentucky, Pennsylvania, and West Virginia, age-adjusted incidence rates were calculated for the rural and nonrural regions of Appalachia. These state rates were compared to rates from the Surveillance, Epidemiology, and End Results (SEER) program for the same years by calculating the adjusted rate ratio (RR) and a 95% confidence interval (CI). FINDINGS: Both the entire and rural Appalachian regions had an adjusted incidence rate for all cancer sites similar to the SEER rate (RR = 1.00 [95% CI, 1.00-1.01] and RR = 0.99 [95% CI, 0.99-1.00], respectively). However, incidence of cancer of the lung/ bronchus, colon, rectum, and cervix in Appalachia was significantly elevated (RR = 1.22 [95% CI, 1.20-1.23], 1.13 [95% CI, 1.11-1.14], 1.19 [95% CI, 1.16-1.22], and 1.12 [95% CI, 1.07-1.17], respectively). Incidence of cancer of the lung/bronchus and cervix in rural Appalachia was even more elevated (RR = 1.34 [95% CI, 1.31-1.36] and 1.29 [95% CI, 1.21-1.38], respectively). Incidence of unstaged disease for all cancer sites in Appalachia (RR = 1.06 [95% CI, 1.05-1.08]), particularly rural Appalachia (RR = 1.28 [95%CI, 1.25-1.301), was elevated. CONCLUSIONS: Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.     

The Association of Dietary Quality Indices and Cancer Mortality: A Systematic Review and Meta-analysis of Cohort Studies

This study aimed to systematically review and do a meta-analysis on available evidence on the association of diet quality indices with cancer mortality. We searched for relevant papers published up to August 2017 through Web of science, PubMed/Medline, Scopus, and Google Scholar. Prospective cohort studies examined the association of any dietary quality indices with cancer mortality were included. Overall, 27 publications were included. There was significant inverse associations between the Dietary Approaches to Stop Hypertension (DASH) diet (HR: 0.85; 95% CI: 0.79, 0.91; I²?=?81.8%), the Alternative Healthy Eating Index (AHEI) (HR: 0.90; 95% CI: 0.85, 0.95; I²: 61.5), the healthy eating index (HEI) (RR: 0.82; 95% CI: 0.75, 0.89; I²: 89.5%) and cancer mortality. Significant associations with the lowest heterogeneity between Diet Quality Index (DQI) (HR: 0.91; 95% CI: 0.89–0.93, I²?=?0.0%), alternative Mediterranean Diet (aMED) (RR: 0.81; 95% CI: 0.78–0.83, I²?=?1.7%), and HEI-2010 (HR: 0.82; 95% CI: 0.69–0.98, I²?=?0.0%) and death due to cancer were also found. However, the Recommended Food Score, Dietary Diversity Score (DDS), and HEI-2005 were not related with cancer mortality. Adherence to DASH diet, AHEI, HEI, DQI, aMED, and HEI-2010 decreased the risk of cancer mortality.