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Algunos autores indican que la poblaci&#243;n inmigrante utiliza menos los servicios de cribado que la aut&#243;ctona&#44; y esto puede estar relacionado con la detecci&#243;n del c&#225;ncer en estadios m&#225;s avanzados<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46; Espa&#241;a ha experimentado un importante proceso migratorio en las &#250;ltimas d&#233;cadas&#46; En 2015&#44; el 13&#44;6&#37; de las personas residentes en Catalu&#241;a &#40;Espa&#241;a&#41; eran al&#243;ctonas<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46; Existe escasa literatura sobre la participaci&#243;n de la poblaci&#243;n inmigrante en el cribado del c&#225;ncer en nuestro pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46; El objetivo principal del estudio fue determinar las diferencias en la participaci&#243;n entre las mujeres aut&#243;ctonas y las al&#243;ctonas en el programa de cribado de c&#225;ncer de mama de Tarragona &#40;PCCMT&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0015" class="elsevierStylePara elsevierViewall">Estudio retrospectivo descriptivo de una cohorte basado en el an&#225;lisis de los datos del PCCMT&#46; 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y el resultado del cribado &#40;tasa de detecci&#243;n y estadio del c&#225;ncer diagnosticado&#41;&#46; Se consider&#243; adherencia en una ronda a la participaci&#243;n de mujeres participantes en la ronda anterior&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Se calcularon porcentajes e intervalos de confianza del 95&#37; &#40;IC95&#37;&#41; y se realizaron pruebas de ji al cuadrado para comparar las variables cualitativas&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los datos fue realizado por el PCCMT&#44; y el tratamiento de la informaci&#243;n se llev&#243; a cabo sin acceder a datos personales&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron 98&#46;456 invitaciones a 40&#46;824 mujeres con nacionalidad conocida&#44; 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Entre las al&#243;ctonas&#44; las m&#225;s j&#243;venes han participado m&#225;s en el programa&#44; mientras que en las aut&#243;ctonas sucede lo contrario&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Algunos autores apuntan diversos factores que explican la baja participaci&#243;n de las mujeres inmigrantes en el cribado mamogr&#225;fico&#44; como tener ambos padres extranjeros&#44; escaso dominio ling&#252;&#237;stico o bajo nivel socioecon&#243;mico y educativo &#40;tambi&#233;n en las aut&#243;ctonas&#41;&#44; ser inmigrante por motivos familiares&#44; inmigrante reciente o refugiada&#44; edad mayor &#40;60-69 a&#241;os&#41; o vivir sola<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#8211;13</span></a>&#46; De los factores relacionados con el sistema sanitario&#44; destaca que el m&#233;dico sea var&#243;n<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; Tambi&#233;n influyen factores culturales&#44; como un conocimiento limitado sobre el c&#225;ncer de mama y el cribado&#44; creencias culturales y barreras psicosociales en el acceso al servicio de cribado&#46; Kristiansen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> sugieren que las mujeres inmigrantes perciben el c&#225;ncer como una enfermedad incurable&#44; debido al contexto sanitario de su pa&#237;s de origen&#44; lo que las lleva a no participar en estos programas&#46; En nuestro estudio no hemos evaluado los factores que influyen en las diferencias de participaci&#243;n entre mujeres aut&#243;ctonas y al&#243;ctonas en el programa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Serral et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> explican que las mujeres de pa&#237;ses con IDH muy alto participan m&#225;s que las de pa&#237;ses con un IDH bajo&#46; Nuestro estudio no encuentra una relaci&#243;n lineal de la participaci&#243;n con el IDH del pa&#237;s de origen &#40;las mujeres de pa&#237;ses con IDH medio participan m&#225;s que las de pa&#237;ses con IDH alto&#41;&#59; esto puede deberse a que en este estudio no se han contemplado las mamograf&#237;as realizadas fuera del programa<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a las tasas de detecci&#243;n por zona geogr&#225;fica&#44; las mujeres de Norteam&#233;rica y Ocean&#237;a&#44; Am&#233;rica Central y del Sur&#44; y Europa Central presentan tasas m&#225;s elevadas que las aut&#243;ctonas&#46; Las mujeres de origen africano &#40;mayormente de Marruecos&#41; son las que tienen las tasas m&#225;s bajas&#46; Estas diferencias pueden estar relacionadas&#44; al menos en parte&#44; con las distintas percepciones del riesgo ligadas a la menor incidencia de c&#225;ncer de mama en los pa&#237;ses de origen de las mujeres &#40;las mayores tasas se dan en pa&#237;ses ricos&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Algunos autores encuentran diagn&#243;sticos en estadios m&#225;s avanzados en las mujeres inmigrantes&#46; Nuestro estudio&#44; centrado en las mujeres participantes en el PCCMT&#44; no avala esta afirmaci&#243;n&#44; pues las mujeres al&#243;ctonas presentaron una distribuci&#243;n por estadios similar a la de las mujeres aut&#243;ctonas&#44; aunque se desconocen los estadios tumorales en las mujeres al&#243;ctonas que no participan en el programa&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La fortaleza de este estudio consiste en disponer de datos administrativos para la nacionalidad&#44; pero debido a la reciente incorporaci&#243;n de esta variable en el Registro Central de Usuarios solo se conoce en un tercio de las mujeres&#44; siendo esta la principal limitaci&#243;n del trabajo&#46; As&#237;&#44; este estudio subraya la necesidad de mejorar la informaci&#243;n clave para dise&#241;ar estrategias de mejora de la participaci&#243;n en los programas de cribado&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; las mujeres al&#243;ctonas presentan menor participaci&#243;n y adherencia al PCCMT que las mujeres aut&#243;ctonas&#44; pero similar distribuci&#243;n de los estadios al diagn&#243;stico&#46; A pesar de sus limitaciones&#44; este primer estudio demuestra la necesidad de mejorar las estrategias de participaci&#243;n de las mujeres al&#243;ctonas en los programas de cribado&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Editora responsable del art&#237;culo</span><p id="par0090" class="elsevierStylePara elsevierViewall">Leila P&#46; Garc&#237;a&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Declaraci&#243;n de transparencia</span><p id="par0095" class="elsevierStylePara elsevierViewall">El autor principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contribuciones de autor&#237;a</span><p id="par0100" class="elsevierStylePara elsevierViewall">A&#46; Ameijide y F&#46; Saladi&#233; han realizado el an&#225;lisis estad&#237;stico de las bases de datos y aportaci&#243;n intelectual al dise&#241;o&#46; L&#46; Laroussy&#44; J&#46;A&#46; Espin&#224;s&#44; J&#46;M&#46; Borr&#224;s y J&#46; Galceran han contribuido en la concepci&#243;n&#44; la b&#250;squeda bibliogr&#225;fica&#44; la redacci&#243;n y el contenido intelectual&#46; Todos&#47;as los&#47;las autores&#47;as contribuyeron a la interpretaci&#243;n de los resultados&#44; la discusi&#243;n y la revisi&#243;n cr&#237;tica del manuscrito&#44; y aprueban su versi&#243;n final&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Agradecimientos</span><p id="par0105" class="elsevierStylePara elsevierViewall">A Xavier Card&#243; por la preparaci&#243;n de las bases de datos para su an&#225;lisis&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Este art&#237;culo se ha realizado con el soporte de la Ag&#232;ncia de Gesti&#243; d&#8217;Ajuts Universitaris i de Recerca AGAUR &#40;2014SGR0635&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0115" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar las diferencias de participaci&#243;n en un programa de cribado de c&#225;ncer de mama entre mujeres aut&#243;ctonas y al&#243;ctonas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo basado en el programa de cribado de c&#225;ncer de mama de la provincia de Tarragona &#40;2008-2015&#41;&#46; La muestra es la poblaci&#243;n diana del programa con pa&#237;s de origen conocido&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cohorte de 40&#46;824 mujeres&#46; Las mujeres al&#243;ctonas participan menos que las aut&#243;ctonas &#40;41&#44;8&#37; <span class="elsevierStyleItalic">vs</span>&#46; 72&#44;3&#37;&#41;&#44; aunque muestran una tasa de detecci&#243;n de c&#225;ncer similar a estas&#44; pero con diferencias seg&#250;n el &#237;ndice de desarrollo humano de su pa&#237;s de origen&#46; Los dos grupos presentan similares estadios tumorales en el momento del diagn&#243;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;59&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ser&#237;a necesario desarrollar estrategias espec&#237;ficamente dirigidas a la poblaci&#243;n inmigrante para mejorar su participaci&#243;n en el cribado del c&#225;ncer de mama&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate the differences between autochthonous and allochthonous women&#39;s participation in a breast cancer screening programme&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective study based on data from the Breast Cancer Screening Programme of the province of Tarragona &#40;2008-2015&#41;&#46; The sample is the target population of the programme with known country of origin&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cohort of 40&#44;824 women&#46; Allochthonous women participate less than autochthonous women &#40;41&#46;8&#37; vs&#46; 72&#46;3&#37;&#41; although they have a similar global detection rate to the latter but with differences according to the human development index of their country of origin&#46; Both groups present similar tumour stages on detection &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;59&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Strategies specifically aimed at the immigrant population are required to improve their participation in breast cancer screening&#46;</p></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">822&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&#44;9-54&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70&#44;3-88&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IDH muy alto</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;344&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">80&#44;9-83&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#44;8-69&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;3-63&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IDH muy alto</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IDH muy alto<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Espa&#241;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IDH muy alto<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>Espa&#241;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;627&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IDH alto</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;609&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IDH medio</span>&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mujeres invitadas y tasas de detecci&#243;n en las rondas 6 a 8 del programa de detecci&#243;n precoz del c&#225;ncer de mama de Tarragona&#44; global&#44; por nacionalidad y por &#237;ndice de desarrollo humano del pa&#237;s de origen</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">&#191;Qu&#233; se sabe sobre el tema&#63;</span><p id="par0080" class="elsevierStylePara elsevierViewall">La participaci&#243;n en programas de cribado es un aspecto clave en su efectividad&#46; La poblaci&#243;n inmigrante utiliza menos los servicios de cribado que la aut&#243;ctona&#44; y esto puede estar relacionado con la detecci&#243;n del c&#225;ncer en estadios m&#225;s avanzados en las mujeres inmigrantes&#46; Hasta este momento&#44; la investigaci&#243;n sobre participaci&#243;n en el cribado de c&#225;ncer de mama en Espa&#241;a solo se ha basado en estudios transversales realizados mediante encuestas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">&#191;Qu&#233; a&#241;ade el estudio realizado a la literatura&#63;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Este es el primer estudio que analiza las diferencias de participaci&#243;n y de detecci&#243;n en un programa poblacional sistem&#225;tico de cribado de c&#225;ncer de mama entre mujeres aut&#243;ctonas e inmigrantes&#46; El estudio confirma que las mujeres inmigrantes participan menos&#44; que las tasas de detecci&#243;n dependen del pa&#237;s de origen y que las distribuciones de los estadios en el momento del diagn&#243;stico son parecidas&#46; Este estudio demuestra la necesidad de mejorar las estrategias de participaci&#243;n de las mujeres al&#243;ctonas en programas de cribado&#46;</p></span></span>"
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                  "contribucion" => array:1 [
                    0 => array:2 [
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                          "etal" => true
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                            0 => "J&#46; Galceran"
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                        "volumen" => "19"
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                          "colaboracion" => "Breast-cancer screening &#8212; viewpoint of the IARC Working Group"
                          "etal" => true
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Revisi&#243;n bibliogr&#225;fica sobre la prevenci&#243;n del c&#225;ncer en personas inmigrantes residentes en Espa&#241;a"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "V&#46; Rodr&#237;guez-Sal&#233;s"
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Salud P&#250;blica&#46;"
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                0 => array:1 [
                  "referenciaCompleta" => "Idescat&#46; Catalunya&#58; Institut d&#8217;Estad&#237;stica de Catalunya&#58; 27 de febrero de 2017&#46; &#40;Consultado el 2 de marzo de 2017&#46;&#41; Disponible en&#58; https&#58;&#47;&#47;www&#46;idescat&#46;cat&#47;indicadors&#47;&#63;id&#61;anuals&#38;n&#61;10332&#38;col&#61;1"
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              "identificador" => "bib0100"
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                0 => array:1 [
                  "referenciaCompleta" => "Programa de las Naciones Unidas para el Desarrollo &#40;PNUD&#41;&#46; Informe sobre desarrollo humano 2015&#46; Nueva York&#59; 2015&#46; &#40;Consultado el 2 de marzo de 2017&#46;&#41; Disponible en&#58; <a target="_blank" href="http://hdr.undp.org/sites/default/files/hdr_2015_report_sp.pdf">http&#58;&#47;&#47;hdr&#46;undp&#46;org&#47;sites&#47;default&#47;files&#47;hdr&#95;2015&#95;report&#95;sp&#46;pdf</a>"
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                  "contribucion" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Breast cancer screening disparities among immigrant women by world region of origin&#58; a population-based study in Ontario&#44; Canada"
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                        0 => array:2 [
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                  "host" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Breast cancer screening disparities among urban immigrants&#58; a population-based study in Ontario&#44; Canada"
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                          "etal" => true
                          "autores" => array:3 [
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "BMC Public Health&#46;"
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                          "etal" => false
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                          "etal" => true
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                            0 => "M&#46; Kristiansen"
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                      "doi" => "10.3109/0284186X.2011.626447"
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                        "tituloSerie" => "Acta Oncol&#46;"
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                0 => array:2 [
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                      "titulo" => "Desigualdades socioecon&#243;micas en el control mamogr&#225;fico en mujeres espa&#241;olas de 45 a 69 a&#241;os de edad"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Serral"
                            1 => "C&#46; Borrell"
                            2 => "R&#46; Puigpin&#243;s i Riera"
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                    0 => array:2 [
                      "doi" => "10.1016/j.gaceta.2016.12.010"
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                        "tituloSerie" => "Gac Sanit&#46;"
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                        "paginaFinal" => "67"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disparities in mammography rate among immigrant and native-born women in the US&#58; progress and challenges"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Yao"
                            1 => "M&#46;M&#46; Hillemeier"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Immigr Minor Health&#46;"
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                        "volumen" => "16"
                        "paginaInicial" => "613"
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                0 => array:2 [
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                      "titulo" => "Estudio de la no participaci&#243;n en el programa de prevenci&#243;n de c&#225;ncer de mama en la ciudad de Valencia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Alcaraz"
                            1 => "A&#46; Lluch"
                            2 => "J&#46; Miranda"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Gac Sanit&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "GLOBOCAN 2012 v1&#46;0&#44; Cancer Incidence and Mortality Worldwide&#58; IARC Cancer Base No&#46; 11"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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Participación de la población inmigrante en el cribado de cáncer de mama de Tarragona, España
Participation of the immigrant population in breast cancer screening in Tarragona, Spain
Lamiaa Laroussya, Alberto Ameijideb, Francina Saladiéb, Josep Alfons Espinàsc, Josep Maria Borràsc, Jaume Galceranb,
Autor para correspondencia
jgalceran@grupsagessa.com

Autor para correspondencia.
a Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
b Programa de Detecció Precoç de Cáncer de Mama de Tarragona, Fundació Lliga per a la Investigació i Prevenció del Càncer, IISPV, Reus (Tarragona), España
c Pla Director d’Oncologia, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, España
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Algunos autores indican que la poblaci&#243;n inmigrante utiliza menos los servicios de cribado que la aut&#243;ctona&#44; y esto puede estar relacionado con la detecci&#243;n del c&#225;ncer en estadios m&#225;s avanzados<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46; Espa&#241;a ha experimentado un importante proceso migratorio en las &#250;ltimas d&#233;cadas&#46; En 2015&#44; el 13&#44;6&#37; de las personas residentes en Catalu&#241;a &#40;Espa&#241;a&#41; eran al&#243;ctonas<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46; Existe escasa literatura sobre la participaci&#243;n de la poblaci&#243;n inmigrante en el cribado del c&#225;ncer en nuestro pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46; El objetivo principal del estudio fue determinar las diferencias en la participaci&#243;n entre las mujeres aut&#243;ctonas y las al&#243;ctonas en el programa de cribado de c&#225;ncer de mama de Tarragona &#40;PCCMT&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0015" class="elsevierStylePara elsevierViewall">Estudio retrospectivo descriptivo de una cohorte basado en el an&#225;lisis de los datos del PCCMT&#46; La muestra fue la poblaci&#243;n invitada &#40;mujeres de 50 a 69 a&#241;os de edad&#41; de las rondas 6 a 8 del PCCMT que abarcaban&#44; seg&#250;n el &#225;rea&#44; entre los a&#241;os 2008 y 2015&#46; Las variables independientes estudiadas fueron las siguientes&#58; edad&#44; nacionalidad administrativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; e &#237;ndice de desarrollo humano del pa&#237;s de origen &#40;IDH&#41;&#46; Los porcentajes de mujeres de las que se conoc&#237;a la nacionalidad en las rondas 6&#44; 7 y 8 fueron 35&#44;2&#37;&#44; 37&#44;1&#37; y 39&#44;0&#37;&#44; respectivamente&#46; El IDH indica el nivel socioecon&#243;mico del pa&#237;s&#44; analizado por el Programa de las Naciones Unidas para el Desarrollo<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#44; y est&#225; clasificado en muy alto&#44; alto&#44; medio y bajo&#46; Las variables dependientes fueron la participaci&#243;n en el cribado &#40;tasas de participaci&#243;n y de adherencia de las mujeres invitadas m&#225;s de una vez&#41; y el resultado del cribado &#40;tasa de detecci&#243;n y estadio del c&#225;ncer diagnosticado&#41;&#46; Se consider&#243; adherencia en una ronda a la participaci&#243;n de mujeres participantes en la ronda anterior&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Se calcularon porcentajes e intervalos de confianza del 95&#37; &#40;IC95&#37;&#41; y se realizaron pruebas de ji al cuadrado para comparar las variables cualitativas&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los datos fue realizado por el PCCMT&#44; y el tratamiento de la informaci&#243;n se llev&#243; a cabo sin acceder a datos personales&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron 98&#46;456 invitaciones a 40&#46;824 mujeres con nacionalidad conocida&#44; 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&#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; No se observaron cambios significativos a lo largo de las diferentes rondas&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Las mujeres al&#243;ctonas presentaron una tasa de detecci&#243;n similar a la de las aut&#243;ctonas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;99&#41;&#46; No obstante&#44; las de pa&#237;ses con IDH alto o muy alto presentaron mayores tasas de detecci&#243;n que las de pa&#237;ses con IDH medio o bajo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">La distribuci&#243;n de los c&#225;nceres por estadios en el momento del diagn&#243;stico fue similar en las mujeres aut&#243;ctonas &#40;0&#58; 9&#44;9&#37;&#59; I&#58; 49&#44;6&#37;&#59; II&#58; 31&#44;3&#37;&#59; III&#58; 7&#44;9&#37;&#59; IV&#58; 1&#44;2&#37;&#41; y al&#243;ctonas &#40;0&#58; 5&#44;7&#37;&#59; I&#58; 62&#44;9&#37;&#59; II&#58; 22&#44;9&#37;&#59; III&#58; 8&#44;6&#37;&#59; IV&#58; 0&#44;0&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;59&#41;&#44; sin diferencias significativas por grupos de edad&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">La participaci&#243;n en el PCCMT fue m&#225;s baja en las mujeres al&#243;ctonas que en las aut&#243;ctonas&#46; Esto tambi&#233;n se observ&#243; en la <span class="elsevierStyleItalic">European Health Interview Survey for Spain</span> de 2009 &#40;70&#37; <span class="elsevierStyleItalic">vs&#46;</span> 36&#37;&#41; y en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#8211;13</span></a>&#46; Entre las al&#243;ctonas&#44; las m&#225;s j&#243;venes han participado m&#225;s en el programa&#44; mientras que en las aut&#243;ctonas sucede lo contrario&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Algunos autores apuntan diversos factores que explican la baja participaci&#243;n de las mujeres inmigrantes en el cribado mamogr&#225;fico&#44; como tener ambos padres extranjeros&#44; escaso dominio ling&#252;&#237;stico o bajo nivel socioecon&#243;mico y educativo &#40;tambi&#233;n en las aut&#243;ctonas&#41;&#44; ser inmigrante por motivos familiares&#44; inmigrante reciente o refugiada&#44; edad mayor &#40;60-69 a&#241;os&#41; o vivir sola<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7&#8211;13</span></a>&#46; De los factores relacionados con el sistema sanitario&#44; destaca que el m&#233;dico sea var&#243;n<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; Tambi&#233;n influyen factores culturales&#44; como un conocimiento limitado sobre el c&#225;ncer de mama y el cribado&#44; creencias culturales y barreras psicosociales en el acceso al servicio de cribado&#46; Kristiansen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> sugieren que las mujeres inmigrantes perciben el c&#225;ncer como una enfermedad incurable&#44; debido al contexto sanitario de su pa&#237;s de origen&#44; lo que las lleva a no participar en estos programas&#46; En nuestro estudio no hemos evaluado los factores que influyen en las diferencias de participaci&#243;n entre mujeres aut&#243;ctonas y al&#243;ctonas en el programa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Serral et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> explican que las mujeres de pa&#237;ses con IDH muy alto participan m&#225;s que las de pa&#237;ses con un IDH bajo&#46; Nuestro estudio no encuentra una relaci&#243;n lineal de la participaci&#243;n con el IDH del pa&#237;s de origen &#40;las mujeres de pa&#237;ses con IDH medio participan m&#225;s que las de pa&#237;ses con IDH alto&#41;&#59; esto puede deberse a que en este estudio no se han contemplado las mamograf&#237;as realizadas fuera del programa<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a las tasas de detecci&#243;n por zona geogr&#225;fica&#44; las mujeres de Norteam&#233;rica y Ocean&#237;a&#44; Am&#233;rica Central y del Sur&#44; y Europa Central presentan tasas m&#225;s elevadas que las aut&#243;ctonas&#46; Las mujeres de origen africano &#40;mayormente de Marruecos&#41; son las que tienen las tasas m&#225;s bajas&#46; Estas diferencias pueden estar relacionadas&#44; al menos en parte&#44; con las distintas percepciones del riesgo ligadas a la menor incidencia de c&#225;ncer de mama en los pa&#237;ses de origen de las mujeres &#40;las mayores tasas se dan en pa&#237;ses ricos&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Algunos autores encuentran diagn&#243;sticos en estadios m&#225;s avanzados en las mujeres inmigrantes&#46; Nuestro estudio&#44; centrado en las mujeres participantes en el PCCMT&#44; no avala esta afirmaci&#243;n&#44; pues las mujeres al&#243;ctonas presentaron una distribuci&#243;n por estadios similar a la de las mujeres aut&#243;ctonas&#44; aunque se desconocen los estadios tumorales en las mujeres al&#243;ctonas que no participan en el programa&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La fortaleza de este estudio consiste en disponer de datos administrativos para la nacionalidad&#44; pero debido a la reciente incorporaci&#243;n de esta variable en el Registro Central de Usuarios solo se conoce en un tercio de las mujeres&#44; siendo esta la principal limitaci&#243;n del trabajo&#46; As&#237;&#44; este estudio subraya la necesidad de mejorar la informaci&#243;n clave para dise&#241;ar estrategias de mejora de la participaci&#243;n en los programas de cribado&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; las mujeres al&#243;ctonas presentan menor participaci&#243;n y adherencia al PCCMT que las mujeres aut&#243;ctonas&#44; pero similar distribuci&#243;n de los estadios al diagn&#243;stico&#46; A pesar de sus limitaciones&#44; este primer estudio demuestra la necesidad de mejorar las estrategias de participaci&#243;n de las mujeres al&#243;ctonas en los programas de cribado&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Editora responsable del art&#237;culo</span><p id="par0090" class="elsevierStylePara elsevierViewall">Leila P&#46; Garc&#237;a&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Declaraci&#243;n de transparencia</span><p id="par0095" class="elsevierStylePara elsevierViewall">El autor principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contribuciones de autor&#237;a</span><p id="par0100" class="elsevierStylePara elsevierViewall">A&#46; Ameijide y F&#46; Saladi&#233; han realizado el an&#225;lisis estad&#237;stico de las bases de datos y aportaci&#243;n intelectual al dise&#241;o&#46; L&#46; Laroussy&#44; J&#46;A&#46; Espin&#224;s&#44; J&#46;M&#46; Borr&#224;s y J&#46; Galceran han contribuido en la concepci&#243;n&#44; la b&#250;squeda bibliogr&#225;fica&#44; la redacci&#243;n y el contenido intelectual&#46; Todos&#47;as los&#47;las autores&#47;as contribuyeron a la interpretaci&#243;n de los resultados&#44; la discusi&#243;n y la revisi&#243;n cr&#237;tica del manuscrito&#44; y aprueban su versi&#243;n final&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Agradecimientos</span><p id="par0105" class="elsevierStylePara elsevierViewall">A Xavier Card&#243; por la preparaci&#243;n de las bases de datos para su an&#225;lisis&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Este art&#237;culo se ha realizado con el soporte de la Ag&#232;ncia de Gesti&#243; d&#8217;Ajuts Universitaris i de Recerca AGAUR &#40;2014SGR0635&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0115" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar las diferencias de participaci&#243;n en un programa de cribado de c&#225;ncer de mama entre mujeres aut&#243;ctonas y al&#243;ctonas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo basado en el programa de cribado de c&#225;ncer de mama de la provincia de Tarragona &#40;2008-2015&#41;&#46; La muestra es la poblaci&#243;n diana del programa con pa&#237;s de origen conocido&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cohorte de 40&#46;824 mujeres&#46; Las mujeres al&#243;ctonas participan menos que las aut&#243;ctonas &#40;41&#44;8&#37; <span class="elsevierStyleItalic">vs</span>&#46; 72&#44;3&#37;&#41;&#44; aunque muestran una tasa de detecci&#243;n de c&#225;ncer similar a estas&#44; pero con diferencias seg&#250;n el &#237;ndice de desarrollo humano de su pa&#237;s de origen&#46; Los dos grupos presentan similares estadios tumorales en el momento del diagn&#243;stico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;59&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ser&#237;a necesario desarrollar estrategias espec&#237;ficamente dirigidas a la poblaci&#243;n inmigrante para mejorar su participaci&#243;n en el cribado del c&#225;ncer de mama&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate the differences between autochthonous and allochthonous women&#39;s participation in a breast cancer screening programme&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective study based on data from the Breast Cancer Screening Programme of the province of Tarragona &#40;2008-2015&#41;&#46; The sample is the target population of the programme with known country of origin&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cohort of 40&#44;824 women&#46; Allochthonous women participate less than autochthonous women &#40;41&#46;8&#37; vs&#46; 72&#46;3&#37;&#41; although they have a similar global detection rate to the latter but with differences according to the human development index of their country of origin&#46; Both groups present similar tumour stages on detection &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;59&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Strategies specifically aimed at the immigrant population are required to improve their participation in breast cancer screening&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Marruecos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;2-47&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Asia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">822&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;1-34&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Am&#233;rica Central y del Sur</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;4-70&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Norteam&#233;rica y Ocean&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IDH muy alto</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IDH muy alto<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Espa&#241;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IDH muy alto<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>Espa&#241;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;139&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;8-69&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IDH bajo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;6-36&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;3-63&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2114259.png"
              ]
            ]
          ]
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2-7&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IDH muy alto<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Espa&#241;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;717&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6-7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IDH muy alto<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>Espa&#241;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;627&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6-7&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IDH alto</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;609&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6-6&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IDH medio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;4-3&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">145&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0-0&#44;0&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mujeres invitadas y tasas de detecci&#243;n en las rondas 6 a 8 del programa de detecci&#243;n precoz del c&#225;ncer de mama de Tarragona&#44; global&#44; por nacionalidad y por &#237;ndice de desarrollo humano del pa&#237;s de origen</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">&#191;Qu&#233; se sabe sobre el tema&#63;</span><p id="par0080" class="elsevierStylePara elsevierViewall">La participaci&#243;n en programas de cribado es un aspecto clave en su efectividad&#46; La poblaci&#243;n inmigrante utiliza menos los servicios de cribado que la aut&#243;ctona&#44; y esto puede estar relacionado con la detecci&#243;n del c&#225;ncer en estadios m&#225;s avanzados en las mujeres inmigrantes&#46; Hasta este momento&#44; la investigaci&#243;n sobre participaci&#243;n en el cribado de c&#225;ncer de mama en Espa&#241;a solo se ha basado en estudios transversales realizados mediante encuestas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">&#191;Qu&#233; a&#241;ade el estudio realizado a la literatura&#63;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Este es el primer estudio que analiza las diferencias de participaci&#243;n y de detecci&#243;n en un programa poblacional sistem&#225;tico de cribado de c&#225;ncer de mama entre mujeres aut&#243;ctonas e inmigrantes&#46; El estudio confirma que las mujeres inmigrantes participan menos&#44; que las tasas de detecci&#243;n dependen del pa&#237;s de origen y que las distribuciones de los estadios en el momento del diagn&#243;stico son parecidas&#46; Este estudio demuestra la necesidad de mejorar las estrategias de participaci&#243;n de las mujeres al&#243;ctonas en programas de cribado&#46;</p></span></span>"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer incidence in Spain&#44; 2015"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Galceran"
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                  "host" => array:1 [
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                      "doi" => "10.1007/s12094-016-1607-9"
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                        "tituloSerie" => "Clin Transl Oncol&#46;"
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                        "volumen" => "19"
                        "paginaInicial" => "799"
                        "paginaFinal" => "825"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28093701"
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                0 => array:2 [
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                      "autores" => array:1 [
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                          "colaboracion" => "Breast-cancer screening &#8212; viewpoint of the IARC Working Group"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Lauby-Secretan"
                            1 => "C&#46; Scoccianti"
                            2 => "D&#46; Loomis"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "volumen" => "372"
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                      ]
                    ]
                  ]
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            2 => array:3 [
              "identificador" => "bib0090"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revisi&#243;n bibliogr&#225;fica sobre la prevenci&#243;n del c&#225;ncer en personas inmigrantes residentes en Espa&#241;a"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Rodr&#237;guez-Sal&#233;s"
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Salud P&#250;blica&#46;"
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                        "volumen" => "88"
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              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Idescat&#46; Catalunya&#58; Institut d&#8217;Estad&#237;stica de Catalunya&#58; 27 de febrero de 2017&#46; &#40;Consultado el 2 de marzo de 2017&#46;&#41; Disponible en&#58; https&#58;&#47;&#47;www&#46;idescat&#46;cat&#47;indicadors&#47;&#63;id&#61;anuals&#38;n&#61;10332&#38;col&#61;1"
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              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Programa de las Naciones Unidas para el Desarrollo &#40;PNUD&#41;&#46; Informe sobre desarrollo humano 2015&#46; Nueva York&#59; 2015&#46; &#40;Consultado el 2 de marzo de 2017&#46;&#41; Disponible en&#58; <a target="_blank" href="http://hdr.undp.org/sites/default/files/hdr_2015_report_sp.pdf">http&#58;&#47;&#47;hdr&#46;undp&#46;org&#47;sites&#47;default&#47;files&#47;hdr&#95;2015&#95;report&#95;sp&#46;pdf</a>"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Social disparities in access to breast and cervical cancer screening by women living in Spain"
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                          "autores" => array:3 [
                            0 => "I&#46; Ricardo-Rodr&#237;gues"
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                      "titulo" => "Inequalities in uptake of breast cancer screening in Spain&#58; analysis of a cross-sectional national survey"
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                          "etal" => true
                          "autores" => array:3 [
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                        "tituloSerie" => "Public Health&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Breast cancer screening disparities among immigrant women by world region of origin&#58; a population-based study in Ontario&#44; Canada"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Vahabi"
                            1 => "A&#46; Lofters"
                            2 => "M&#46; Kumar"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Cancer Med&#46;"
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                        "paginaInicial" => "1670"
                        "paginaFinal" => "1686"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Breast cancer screening disparities among urban immigrants&#58; a population-based study in Ontario&#44; Canada"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Vahabi"
                            1 => "A&#46; Lofters"
                            2 => "M&#46; Kumar"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Public Health&#46;"
                        "fecha" => "2015"
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            9 => array:3 [
              "identificador" => "bib0125"
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                      "titulo" => "Participation in cancer screening among female migrants and non-migrants in Germany"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Brzoska"
                            1 => "C&#46; Abdul-Rida"
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                      "titulo" => "Participation in mammography screening among migrants and non-migrants in Denmark"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Kristiansen"
                            1 => "B&#46;L&#46; Thorsted"
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                      "doi" => "10.3109/0284186X.2011.626447"
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                        "tituloSerie" => "Acta Oncol&#46;"
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                        "volumen" => "51"
                        "paginaInicial" => "28"
                        "paginaFinal" => "36"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Desigualdades socioecon&#243;micas en el control mamogr&#225;fico en mujeres espa&#241;olas de 45 a 69 a&#241;os de edad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Serral"
                            1 => "C&#46; Borrell"
                            2 => "R&#46; Puigpin&#243;s i Riera"
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                    0 => array:2 [
                      "doi" => "10.1016/j.gaceta.2016.12.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit&#46;"
                        "fecha" => "2018"
                        "volumen" => "32"
                        "paginaInicial" => "61"
                        "paginaFinal" => "67"
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ISSN: 02139111
Idioma original: Español
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