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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El c&#225;ncer de mama es la enfermedad oncol&#243;gica m&#225;s frecuente en las mujeres de todo el mundo&#46; En Espa&#241;a&#44; cada a&#241;o se diagnostican 26&#46;000 nuevos casos&#44; que constituyen el 30&#37; de todos los tumores en las mujeres<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Entre los a&#241;os 1960 y 1980 se realizaron ensayos cl&#237;nicos que demostraron que la detecci&#243;n precoz de estos tumores mediante mamograf&#237;a se asociaba a una disminuci&#243;n de la mortalidad de un 15-20&#37;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; A partir de estos resultados se recomendaron los programas de cribado<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">3</span></a>&#44; que en nuestro entorno son poblacionales&#46; No obstante&#44; todav&#237;a se diagnostican c&#225;nceres en la pr&#225;ctica asistencial<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Mediante los programas de cribado se detectan tumores m&#225;s peque&#241;os y con menor afectaci&#243;n regional&#44; lo que permite optar por tratamientos menos agresivos<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; disminuyendo los efectos adversos y mejorando el pron&#243;stico&#46; Los c&#225;nceres diagnosticados cuando ya presentan cl&#237;nica&#44; incluyendo los c&#225;nceres de intervalo<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">7</span></a>&#44; son tumores que se encuentran en fases m&#225;s avanzadas&#44; lo cual suele implicar un mayor tama&#241;o y que la axila est&#233; afectada&#44; por lo que requieren tratamientos m&#225;s agresivos<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas y el estadio de los tumores determinar&#225;n el tipo de tratamiento&#46; Para los estadios I y II&#44; el tratamiento con cirug&#237;a conservadora y radioterapia ha sustituido a las cirug&#237;as radicales con id&#233;ntica supervivencia&#46; La quimioterapia adyuvante mejora las tasas de supervivencia independientemente de la edad&#44; la afectaci&#243;n ganglionar y la sensibilidad hormonal<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">8</span></a>&#46; La radioterapia complementaria reduce el porcentaje de recidivas locorregionales y mejora la supervivencia&#46; Finalmente&#44; la hormonoterapia es eficaz en todas las pacientes con tumores con receptores hormonales positivos<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">8</span></a> y se est&#225; utilizando de forma neoadyuvante en mujeres posmenop&#225;usicas<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los efectos secundarios o adversos de la quimioterapia dependen del tipo&#44; la dosis y la duraci&#243;n del tratamiento&#46; La ca&#237;da del cabello&#44; las alteraciones ungueales&#44; las n&#225;useas y los v&#243;mitos son algunos de ellos&#44; pero estos dos &#250;ltimos son los s&#237;ntomas m&#225;s frecuentes derivados de la quimioterapia&#46; Adem&#225;s&#44; la leucocitopenia hace aumentar la incidencia de infecciones y la afectaci&#243;n de las c&#233;lulas del sistema digestivo causa diarreas<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; Normalmente estos efectos adversos desaparecen una vez finalizado el tratamiento&#46; La radioterapia puede provocar disfagia&#44; tos irritativa y eritema &#40;este &#250;ltimo con m&#225;s frecuencia&#41;&#44; o bien efectos cr&#243;nicos como pigmentaci&#243;n de la piel y fibrosis pulmonar<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">8</span></a>&#46; Aunque cabe mencionar que los efectos adversos de la radioterapia var&#237;an considerablemente seg&#250;n el tipo de tratamiento y los tejidos tratados&#44; la dermitis aguda es el efecto m&#225;s frecuente e importante en los tumores de mama<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a>&#46; Los efectos adversos de la hormonoterapia dependen en gran parte del tipo de tratamiento administrado&#44; pero los m&#225;s comunes son los sofocos&#44; los sudores nocturnos y la sequedad vaginal<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Entendemos como terapias no convencionales aquellos cuidados para la salud&#44; pr&#225;cticas o productos que no pertenecen a la atenci&#243;n sanitaria habitual&#46; Cuando se usan junto con el tratamiento convencional se las considera complementarias&#44; y cuando lo sustituyen&#44; alternativas<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a>&#46; En las personas con c&#225;ncer suelen usarse para ayudar a paliar los efectos adversos de los tratamientos&#46; Por otro lado&#44; tambi&#233;n se utilizan terapias de autoayuda&#44; entendidas como la pr&#225;ctica de t&#233;cnicas para aumentar la calidad de vida&#44; como por ejemplo la meditaci&#243;n y el Tai Chi&#46; Las terapias no convencionales y de autoayuda m&#225;s frecuentes en nuestro medio son la acupuntura&#44; la fitoterapia o herbolario&#44; la homeopat&#237;a&#44; las terapias psicosom&#225;ticas&#44; los masajes&#44; las terapias nutricionales &#40;toma de vitaminas o de suplementos nutricionales&#41;&#44; el Reiki y la reflexolog&#237;a<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; En Alemania se han observado un creciente inter&#233;s y una mayor utilizaci&#243;n de estas terapias en pacientes con c&#225;ncer de mama avanzado<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">17</span></a>&#46; En general&#44; sobre todo en los pa&#237;ses occidentales&#44; no hay evidencia sobre la eficacia de muchos de estos tratamientos y se desconocen sus efectos adversos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Este estudio tiene por objetivo describir y analizar las caracter&#237;sticas de las mujeres y de los tumores en la cohorte DAMA seg&#250;n hayan sido diagnosticados en un programa de cribado poblacional o por s&#237;ntomas&#46; A su vez&#44; se analizan los efectos adversos de los tratamientos recibidos y la utilizaci&#243;n de terapias no convencionales&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0040" class="elsevierStylePara elsevierViewall">Dise&#241;o descriptivo anidado en un estudio de cohortes mixto retrospectivo-prospectivo de la Cohorte DAMA&#44; compuesta por 2235 mujeres diagnosticadas de c&#225;ncer de mama en cuatro hospitales universitarios p&#250;blicos de Barcelona &#40;Hospital Cl&#237;nic&#44; Hospital Universitari Vall d&#8217;Hebron&#44; Hospital de la Santa Creu i Sant Pau y Parc de Salut Mar&#41;&#46; Las mujeres se identificaron a partir del Conjunto M&#237;nimo B&#225;sico de Datos y se incluyeron todas las mayores de 18 a&#241;os que tuvieran un diagn&#243;stico principal codificado entre los c&#243;digos CIE-9 174&#46;0 y 179&#46;9 del 1 de enero de 2003 al 31 de diciembre de 2013&#46; Se excluyeron las mujeres diagnosticadas de c&#225;ncer de mama que no estaban en edad de cribado&#44; as&#237; como las diagnosticadas anteriormente de otro tipo de c&#225;ncer y las residentes fuera de Catalu&#241;a<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Una vez aceptado y firmado el consentimiento informado&#44; se realiz&#243; una encuesta telef&#243;nica en la que se recogieron datos sociodemogr&#225;ficos de las mujeres&#46; Posteriormente se realiz&#243;&#44; <span class="elsevierStyleItalic">on-line</span> o en papel&#44; un cuestionario autoadministrado sobre el estado de salud en el que&#44; entre otros&#44; se inclu&#237;an la v&#237;a diagn&#243;stica del c&#225;ncer&#44; datos sobre el c&#225;ncer de mama&#44; su tratamiento y complicaciones&#44; y uso de terapias no convencionales&#46; Por &#250;ltimo&#44; se revisaron las historias cl&#237;nicas de las pacientes y se recogieron datos cl&#237;nicos relevantes relacionados con el diagn&#243;stico y las caracter&#237;sticas del c&#225;ncer de mama&#44; los tratamientos&#44; las reca&#237;das y las visitas de seguimiento&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La variable dependiente fue la v&#237;a de diagn&#243;stico del c&#225;ncer de mama&#44; agrupada en&#58; 1&#41; programa poblacional de detecci&#243;n precoz del c&#225;ncer de mama &#40;PDPCM&#41; o 2&#41; revisi&#243;n m&#233;dica habitual&#44; tras notarse un bulto&#44; por seguimiento cl&#237;nico de factores de riesgo o por otros signos o s&#237;ntomas &#40;no-PDPCM&#41;&#46; Las variables explicativas fueron la edad &#40;agrupada en 50-54&#44; 55-59&#44; 60-64 y 65-69 a&#241;os&#41;&#44; el &#237;ndice de masa corporal &#40;IMC&#41; distinguiendo bajo peso &#40;IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>18&#44;5&#41;&#44; normopeso &#40;IMC 18&#44;5-24&#44;9&#41;&#44; sobrepeso &#40;IMC 25-29&#44;9&#41; y obesidad &#40;IMC &#8805;30&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a>&#44; la clase social basada en la ocupaci&#243;n de la mujer o del sustentador principal del hogar seg&#250;n la Clasificaci&#243;n Nacional de Ocupaciones &#40;CON-201&#41; y clasificada en tres categor&#237;as seg&#250;n la adaptaci&#243;n espa&#241;ola de la <span class="elsevierStyleItalic">British Registrar General Classification</span> en alta &#40;I y II&#41;&#44; media &#40;III&#41; y baja &#40;IV y V&#41;&#44; y la renta familiar disponible agrupada en cuartiles como baja &#40;&#60;76&#44;1&#41;&#44; media-baja &#40;76&#44;1-89&#44;6&#41;&#44; media-alta &#40;89&#44;6-109&#44;5&#41; y alta &#40;&#8805;109&#44;5&#41;&#46; La renta familiar disponible es un &#237;ndice compuesto por cinco indicadores socio-econ&#243;micos&#58; tasa de titulados superiores en la poblaci&#243;n&#44; situaci&#243;n laboral entendida como el ratio entre desempleados y poblaci&#243;n en edad de trabajar&#44; n&#250;mero de coches en relaci&#243;n con la poblaci&#243;n&#44; potencia de los nuevos coches adquiridos por los residentes del &#225;rea y precios del mercado residencial de segunda mano&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Como variables explicativas cl&#237;nicas se establecieron el tipo de tumor &#40;<span class="elsevierStyleItalic">in situ</span> o invasivo&#41;&#44; el grado histol&#243;gico &#40;I&#44; II&#44; III o no aplicable&#41;&#44; el estadio del tumor en el momento del diagn&#243;stico &#40;<span class="elsevierStyleItalic">in situ&#44;</span> I&#44; II&#44; III o IV&#41; y la presencia o no de recidivas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para cada tipo de tratamiento recibido se estudiaron los efectos adversos&#46; Los derivados de la quimioterapia fueron ca&#237;da del cabello&#44; v&#243;mitos&#44; alteraciones en el ritmo deposicional &#40;diarrea o estre&#241;imiento&#41;&#44; alteraciones en el sentido del gusto&#44; &#250;lceras en la cavidad oral&#44; alteraciones ungueales y disminuci&#243;n de la actividad del sistema inmunitario&#46; En relaci&#243;n con la radioterapia&#44; los efectos adversos considerados fueron descamaci&#243;n de la piel y cansancio referido como mayor de lo habitual&#46; Finalmente&#44; los efectos derivados del tratamiento hormonal fueron aumento de peso&#44; sofocos&#44; dolores articulares&#44; osteoporosis y cambios en la menstruaci&#243;n&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Respecto a las terapias no convencionales&#44; se distingui&#243; entre terapias y t&#233;cnicas de autoayuda&#46; Se pregunt&#243; a las mujeres si acudieron al quiropr&#225;ctico&#44; al oste&#243;pata&#44; al home&#243;pata&#44; al acupuntor&#44; al herborista o al m&#233;dico naturista o natur&#243;pata&#44; y se analizaron concretamente las de manipulaci&#243;n&#46; En referencia a la autoayuda&#44; se consideraron la meditaci&#243;n&#44; el yoga&#44; el Qigong&#44; el Tai Chi&#44; el Reiki&#44; las t&#233;cnicas de relajaci&#243;n&#44; la visualizaci&#243;n y la sanaci&#243;n espiritual&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;sticos</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se utilizaron descriptivos bivariados de las diferentes variables del estudio en funci&#243;n de la variable dependiente v&#237;a de diagn&#243;stico&#44; analizando la existencia de diferencias estad&#237;sticamente significativas con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; mediante la prueba de ji al cuadrado o el test exacto de Fisher&#46; Se ajustaron modelos de regresi&#243;n log&#237;stica univariados y multivariados para obtener <span class="elsevierStyleItalic">odds ratio</span> crudas &#40;ORc&#41; y ajustadas &#40;ORa&#41; con sus intervalos de confianza del 95&#37; &#40;IC95&#37;&#41;&#46; Las variables de ajuste se seleccionaron de acuerdo con las hip&#243;tesis del estudio independientemente de que fueran o no significativas en los modelos&#46; Se realizaron tambi&#233;n modelos de regresi&#243;n log&#237;stica crudos para cada una de las complicaciones y efectos adversos de los tratamientos recibidos&#44; as&#237; como para las terapias de autoayuda&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; se representaron en gr&#225;ficas la frecuentaci&#243;n de profesionales de terapias no convencionales y la frecuentaci&#243;n de la realizaci&#243;n de estos tratamientos&#46; Tambi&#233;n se represent&#243; gr&#225;ficamente la frecuentaci&#243;n del uso de terapias de autoayuda seg&#250;n la v&#237;a de diagn&#243;stico&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico se usaron los programas R versi&#243;n 3&#46;2&#46;4 y SPSS versi&#243;n 23&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">De las 2235 mujeres de la Cohorte DAMA se excluyeron 41 del estudio por no disponer de informaci&#243;n sobre la v&#237;a de diagn&#243;stico y 928 por no estar dentro del rango de edad de cribado &#40;50-69 a&#241;os&#41;&#46; Aproximadamente un 40&#37; de los c&#225;nceres fueron diagnosticados mediante cribado &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Se encontraron diferencias significativas en la edad y la renta familiar disponible&#46; En la v&#237;a diagn&#243;stica PDPCM predominaron los grupos de edad centrales &#40;27&#44;7&#37; en 55-59 a&#241;os y 25&#44;5&#37; en 60-64 a&#241;os&#41;&#44; mientras que en no-PDPCM predominaron las mujeres m&#225;s j&#243;venes &#40;32&#44;3&#37; en 55-59 a&#241;os y 26&#44;3&#37; en 60-64 a&#241;os&#41;&#46; En relaci&#243;n a la renta familiar disponible&#44; el grupo de mayor renta fue el m&#225;s frecuente en las dos v&#237;as de diagn&#243;stico &#40;29&#44;0&#37; en PDPCM y 28&#44;2&#37; en no-PDPCM&#41;&#46; En relaci&#243;n con el IMC&#44; en PDPCM predominan las mujeres con sobrepeso &#40;40&#44;6&#37;&#41;&#44; mientras que en no-PDPCM predominan las mujeres con normopeso &#40;44&#44;9&#37;&#41;&#44; sin que la diferencia llegue a ser significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;130&#41;&#46; La mayor&#237;a de las mujeres fueron de clase social alta &#40;46&#44;5&#37; en PDPCM y 42&#44;0&#37; en no-PDPCM&#41;&#44; sin encontrar significaci&#243;n estad&#237;stica en la comparaci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;282&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En el descriptivo de las variables relacionadas con los tumores se hallaron diferencias significativas en las cuatro variables estudiadas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El tumor invasivo fue el m&#225;s frecuente en los dos grupos &#40;81&#44;7&#37; en PDPCM y 88&#44;9&#37; en no-PDPCM&#41;&#46; Respecto al grado histol&#243;gico&#44; en ambas v&#237;as de diagn&#243;stico la mitad de las mujeres presentaron grado II &#40;52&#44;4&#37; en PDPCM y 53&#44;8&#37; en no-PDPCM&#41;&#44; seguido del grado I en PDPCM &#40;30&#44;9&#37;&#41; y del grado III en no-PDPCM &#40;28&#44;2&#37;&#41;&#46; La mayor&#237;a de los tumores se encontraban en estadios poco avanzados &#40;PDPCM&#58; 57&#44;4&#37; y 23&#44;1&#37; en estadios I y II&#44; respectivamente&#59; no-PDPCM&#58; 50&#44;8&#37; y 30&#44;6&#37; en estadios I y II&#44; respectivamente&#41;&#46; Las mujeres diagnosticadas mediante PDPCM presentaron menos recidivas que las diagnosticadas por no-PDPCM &#40;3&#44;2&#37; y 10&#44;9&#37;&#44; respectivamente&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> tambi&#233;n se muestran los resultados de las asociaciones crudas y ajustadas seg&#250;n la v&#237;a diagn&#243;stica&#46; En el an&#225;lisis bivariado se observa m&#225;s riesgo de ser diagnosticadas por PDPCM en las mujeres de menor y mayor edad &#40;ORc&#58; 0&#44;72&#44; IC95&#37;&#58; 0&#44;53-0&#44;98&#44; en 50-54 a&#241;os&#59; ORc&#58; 0&#44;54&#44; IC95&#37;&#58; 0&#44;38-0&#44;75&#44; en 65-69 a&#241;os&#41;&#44; y en las de renta familiar disponible media-alta &#40;ORc&#58; 0&#44;67&#44; IC95&#37;&#58; 0&#44;47-0&#44;96&#41;&#46; En el modelo ajustado se mantiene el riesgo en los grupos de menor y mayor edad &#40;ORa&#58; 0&#44;66&#44; IC95&#37;&#58; 0&#44;44-1&#44;00&#44; en 50-54 a&#241;os&#59; ORa&#58; 0&#44;35&#44; IC95&#37;&#58; 0&#44;35-0&#44;89&#44; en 65-69 a&#241;os&#41;&#44; y las mujeres de clase social baja presentan mayor riesgo de ser diagnosticadas por no-PDPCM &#40;ORa&#58;1&#44;54&#59; IC95&#37;&#58; 1&#44;02-2&#44;32&#41;&#46; En cuanto a las caracter&#237;sticas de los tumores&#44; en el an&#225;lisis bivariado se observ&#243; que los c&#225;nceres invasivos&#44; los de mayor grado histol&#243;gico&#44; los de estadio m&#225;s avanzado y los recidivantes tienen m&#225;s probabilidades de ser diagnosticados por no-PDPCM que los c&#225;nceres <span class="elsevierStyleItalic">in situ</span> &#40;ORc&#58; 1&#44;80&#59; IC95&#37;&#58;1&#44;29-2&#44;50&#41;&#44; los de grado histol&#243;gico I &#40;ORc&#58; 1&#44;77&#59; IC95&#37;&#58; 1&#44;28-2&#44;45&#41; y III &#40;ORc&#58; 2&#44;93&#59; IC95&#37;&#58; 1&#44;96-4&#44;37&#41;&#44; los de estadio 0 &#40;estadio I&#44; ORc&#58; 1&#44;52&#44; IC95&#37;&#58; 1&#44;03-2&#44;24&#59; estadio II&#44; ORc&#58; 2&#44;28&#44; IC95&#37;&#58;1&#44;49-3&#44;49&#59; estadio III&#44; ORc&#58; 3&#44;64&#44; IC95&#37;&#58; 1&#44;94-6&#44;83&#41; y los no recidivantes &#40;ORc&#58; 3&#44;64&#59; IC95&#37;&#58; 1&#44;94-6&#44;83&#41;&#46; En el an&#225;lisis multivariante&#44; el incremento del riesgo se concentra en los grados histol&#243;gicos II &#40;ORa&#58; 1&#44;60&#59; IC95&#37;&#58; 1&#44;07-2&#44;38&#41; y III &#40;ORa&#58; 2&#44;18&#59; IC95&#37;&#58; 1&#44;31-3&#44;63&#41;&#44; el estadio III &#40;ORa&#58; 3&#44;29&#59; IC95&#37;&#58; 1<span class="elsevierStyleBold">&#44;</span>04-10&#44;43&#41; y la presencia de recidivas &#40;ORa&#58; 2&#44;14&#59; IC95&#37;&#58; 1&#44;02-4&#44;47&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra los efectos adversos de los tratamientos&#46; Recibieron quimioterapia en alg&#250;n momento a lo largo del proceso de tratamiento el 91&#44;8&#37; de las mujeres PDPCM y el 94&#44;4&#37; de las no-PDPCM&#46; Se observaron diferencias en todos los efectos adversos estudiados&#44; que siempre fueron m&#225;s frecuentes en el grupo de mujeres no-PDPCM&#46; Destaca la ca&#237;da del cabello &#40;70&#44;8&#37; en no-PDPCM vs&#46; 53&#44;9&#37; en PDPCM&#41;&#44; seguida de las alteraciones ungueales &#40;45&#44;0&#37; vs&#46; 31&#44;3&#37;&#41; y las alteraciones en el sentido del gusto &#40;43&#44;3&#37; vs&#46; 29&#44;3&#37;&#41;&#46; En el an&#225;lisis bivariado se observ&#243; un mayor riesgo de presentar efectos adversos en el grupo no-PDPCM que en el grupo PDPCM&#46; Los efectos adversos que presentaron mayor riesgo fueron la ca&#237;da del cabello &#40;ORc&#58; 2&#44;08&#59; IC95&#37;&#58; 1&#44;61-2&#44;68&#41;&#44; las &#250;lceras en la cavidad oral &#40;ORc&#58; 1&#44;88&#59; IC95&#37;&#58; 1&#44;42-2&#44;49&#41;&#44; las alteraciones en el sentido del gusto &#40;ORc&#58; 1&#44;85&#59; IC95&#37;&#58; 1&#44;45-2&#44;35&#41; y las alteraciones ungueales &#40;ORc&#58; 1&#44;80&#59; IC95&#37;&#58; 1&#44;42-2&#44;28&#41;&#46; En cuanto a la radioterapia&#44; la recibieron 393 &#40;78&#44;8&#37;&#41; mujeres del grupo PDPCM y 608 &#40;79&#44;3&#37;&#41; mujeres del grupo no-PDPCM&#44; y no se encontraron diferencias en las alteraciones cut&#225;neas ni en el cansancio&#46; Finalmente&#44; recibieron hormonoterapia 409 &#40;82&#44;0&#37;&#41; mujeres del grupo PDPCM y 641 &#40;83&#44;6&#37;&#41; mujeres del grupo no-PDPCM&#44; y el &#250;nico efecto que mostr&#243; diferencias en el modelo univariado fue la presencia de osteoporosis en las mujeres no-PDPCM &#40;ORc&#58; 1&#44;35&#59; IC95&#37;&#58; 1&#44;01-1&#44;80&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Respecto a las terapias no convencionales&#44; las mujeres del grupo no-PDPCM visitaron con mayor frecuencia al herborista &#40;9&#44;5&#37;&#41; y al home&#243;pata &#40;9&#44;0&#37;&#41;&#44; con diferencias significativas para el herborista &#40;ORc&#58; 1&#44;64&#59; IC95&#37;&#58; 1&#44;06-2&#44;56&#41;&#46; En cuanto al tipo de terapias no convencionales&#44; no se observan diferencias en ninguna de ellas&#44; pero la m&#225;s frecuente en ambos grupos es la homeopat&#237;a &#40;8&#44;8&#37; en PDPCM y 11&#44;0&#37; en no-PDPCM&#41;&#44; seguida por las plantas medicinales &#40;8&#44;0&#37; y 10&#44;7&#37;&#44; respectivamente&#41; referidas a la herbolaria en general &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">En cuanto a la autoayuda&#44; se observaron diferencias en Tai Chi&#44; Reiki y las t&#233;cnicas de relajaci&#243;n&#44; siendo las mujeres del grupo no-PDPCM las que m&#225;s las utilizaron&#46; En el an&#225;lisis bivariado&#44; esta relaci&#243;n es significativa para el Reiki &#40;ORc&#58; 1&#44;96&#59; IC95&#37;&#58; 1&#44;23-3&#44;14&#41; y las t&#233;cnicas de relajaci&#243;n &#40;ORc&#58; 1&#44;84&#59; IC95&#37;&#58; 1&#44;27-2&#44;68&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se representa gr&#225;ficamente la frecuentaci&#243;n de profesionales de terapias no convencionales y los tratamientos recibidos seg&#250;n la v&#237;a de diagn&#243;stico&#46; El profesional con mayor frecuentaci&#243;n fue el herborista &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;&#44; mientras que los que muestran m&#225;s reiteraci&#243;n de visitas son los quiropr&#225;cticos&#44; seguidos de los acupuntores&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">En cuanto a la frecuentaci&#243;n&#44; m&#225;s del 50&#37; de las mujeres que usaron terapias no convencionales lo hicieron m&#225;s de dos veces&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Como puede observarse en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#44; las terapias de autoayuda suelen presentar una frecuentaci&#243;n alta&#44; y destacan la meditaci&#243;n&#44; el Qui-gong&#44; el Tai-chi y el yoga&#46; Se observan peque&#241;as diferencias seg&#250;n el m&#233;todo diagn&#243;stico&#58; el grupo PDPCM frecuenta m&#225;s la meditaci&#243;n y el Qui-gong&#44; mientras que en el grupo no-PDPCM predomina el Tai-chi&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">El principal hallazgo de este estudio es que las mujeres de la Cohorte DAMA diagnosticadas en los PDPCM presentan tumores m&#225;s diferenciados y en estadios menos evolucionados&#46; Por otro lado&#44; los tratamientos asociados a las mujeres diagnosticadas en los PDPCM presentan menos efectos adversos&#44; y las mujeres recurren menos a terapias no convencionales&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Los PDPCM invitan a todas las mujeres y favorecen la equidad&#46; Las mujeres se controlan m&#225;s<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a> y se contribuye a la disminuci&#243;n de las desigualdades<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Factores como el nivel de conocimientos en salud&#44; la presi&#243;n del tiempo para acudir a la mamograf&#237;a&#44; los problemas de transporte o la incomodidad para interactuar con los profesionales sanitarios pueden explicar las diferencias entre el nivel socioecon&#243;mico y la participaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; No obstante&#44; las mujeres de estatus socioecon&#243;mico m&#225;s alto siguen siendo las que m&#225;s se controlan de manera regular&#46; En nuestro estudio se demuestra que el menor estatus socioecon&#243;mico es un factor de riesgo para el c&#225;ncer de mama&#44; independientemente de la v&#237;a diagn&#243;stica&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Los resultados obtenidos respecto al grado de diferenciaci&#243;n de los tumores coinciden con los publicados por Salvad&#243; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> en que los detectados mediante PDPCM son bien diferenciados&#46; De la misma forma&#44; presentan m&#225;s ductales <span class="elsevierStyleItalic">in situ</span> y en estadios iniciales&#44; con un menor porcentaje de recidivas<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Detectar tumores no invasivos se considera un factor predictivo de la supervivencia&#44; probablemente determinado por el grado de agresividad biol&#243;gica del tumor&#46; Por otra parte&#44; la detecci&#243;n en un estadio inicial&#44; calculado mediante la clasificaci&#243;n TNM&#44; es un indicador de probabilidad de recidiva a largo plazo y de supervivencia<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">26&#44;27</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Una de las aportaciones de los PDPCM es un manejo menos agresivo en estadios precoces<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">28</span></a>&#46; La cirug&#237;a conservadora asociada a tratamientos locales con radioterapia&#44; y a tratamientos sist&#233;micos con quimioterapia y hormonoterapia dependiendo de las caracter&#237;sticas del tumor&#44; est&#225; sustituyendo a la cirug&#237;a radical&#46; El mayor porcentaje observado de radioterapia en las mujeres diagnosticadas en PDPCM corresponde a la realizada despu&#233;s de la cirug&#237;a conservadora en los estadios I y II&#46; Esta asociaci&#243;n ha demostrado una reducci&#243;n del riesgo de reca&#237;da locorregional y de enfermedad a distancia&#44; y un aumento de la supervivencia global<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">29&#44;30</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La correlaci&#243;n entre el estadio del tumor&#44; el tipo de cirug&#237;a y los efectos adversos se observa en nuestro estudio y tambi&#233;n en la bibliograf&#237;a consultada&#46; El grupo PDPCM&#44; probablemente debido a la menor agresividad de los tratamientos&#44; present&#243; menos efectos adversos de la quimioterapia y menos osteoporosis derivada de la hormonoterapia&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Aunque las cifras reportadas por un estudio que incluy&#243; 11 pa&#237;ses de Europa indican una prevalencia del uso de terapias no convencionales en las mujeres con c&#225;ncer de mama del 44&#44;7&#37;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">31</span></a>&#44; otros estudios m&#225;s recientes muestran prevalencias que van del 62&#44;9&#37; en Alemania<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">32</span></a> al 86&#44;1&#37; en los Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a>&#44; siendo especialmente frecuente en los tumores en estadio avanzado<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">34</span></a>&#46; Analizando nuestros resultados vemos que tambi&#233;n existe correlaci&#243;n entre la agresividad del tumor y la frecuentaci&#243;n de los diferentes profesionales de terapias no convencionales&#44; especialmente de los herboristas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento ofrecido por los herboristas&#44; los principales motivos de consulta son para que se les recomienden plantas para reforzar el sistema inmunitario&#44; inhibir el crecimiento de tumores o combatir el cansancio<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">35</span></a>&#46; Resulta l&#243;gico pensar que sean las mujeres diagnosticadas fuera de los PDPCM&#44; que presentan estadios m&#225;s avanzados y m&#225;s efectos adversos&#44; las que m&#225;s utilizan las terapias no convencionales&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Respecto a las limitaciones del estudio&#44; cabe mencionar un sesgo de selecci&#243;n debido a que las mujeres fueron reclutadas de hospitales p&#250;blicos y no es posible garantizar la representatividad de la muestra&#46; Aun as&#237;&#44; los hospitales participantes son los m&#225;s importantes de Barcelona y los que atienden la mayor proporci&#243;n de casos&#46; La informaci&#243;n de la cohorte fue en su mayor&#237;a autorreportada&#44; con la posible presencia de un sesgo de informaci&#243;n&#46; Y una &#250;ltima limitaci&#243;n es que los datos presentados corresponden a un corte transversal&#44; por lo que no permiten establecer causalidad&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la implantaci&#243;n de los PDPCM ha demostrado tener un impacto significativo en la detecci&#243;n de tumores en estadios iniciales&#44; lo que proporciona a las pacientes mayores posibilidades de acceder a tratamientos m&#225;s conservadores y&#44; por lo tanto&#44; con efectos adversos de menor impacto en su vida&#44; lo que se traduce en una menor necesidad de recurrir a terapias no convencionales en comparaci&#243;n con las mujeres que presentan tumores m&#225;s agresivos&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Editora responsable del art&#237;culo</span><p id="par0190" class="elsevierStylePara elsevierViewall">Mercedes Carrasco Porti&#241;o&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Declaraci&#243;n de transparencia</span><p id="par0195" class="elsevierStylePara elsevierViewall">La autora 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="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Contribuciones de autor&#237;a</span><p id="par0200" class="elsevierStylePara elsevierViewall">J&#46; Grau&#44; investigador de la Cohorte DAMA y coordinador de los programas de detecci&#243;n precoz del Hospital Cl&#237;nic&#44; dise&#241;&#243; el estudio&#46; I&#46; Tor&#225;&#44; estad&#237;stica y <span class="elsevierStyleItalic">data manager</span> de los programas de detecci&#243;n precoz&#44; junto con B&#46; Oliver&#44; estudiante de &#250;ltimo curso del grado de Medicina&#44; han trabajado activamente en el an&#225;lisis de los datos&#46; Los tres participaron en la b&#250;squeda bibliogr&#225;fica&#44; el an&#225;lisis de los resultados y la redacci&#243;n de los distintos borradores del manuscrito&#46; X&#46; Bargall&#243; es investigador de la Cohorte DAMA y responsable del cribado de c&#225;ncer de mama por la parte del diagn&#243;stico por la imagen&#59; ha contribuido en la redacci&#243;n del manuscrito y la selecci&#243;n de las variables de estudio en cuanto a las terapias no convencionales&#46; M&#46; Aldea es la responsable del programa de cribado de c&#225;ncer de mama del Hospital Cl&#237;nic&#59; ha revisado y contribuido en la redacci&#243;n del manuscrito&#46; R&#46; Puigpin&#243;s-Riera es la investigadora principal del Proyecto DAMA&#59; ha revisado y contribuido en las distintas versiones del manuscrito&#44; y particip&#243; en la selecci&#243;n de las variables necesarias para llevar a cabo el estudio&#46; Los miembros del Grupo de trabajo Cohorte DAMA participan aportando los datos de sus respectivos hospitales y con lecturas cr&#237;ticas de los manuscritos y trabajos diversos que emanan de los resultados obtenidos del estudio&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Agradecimientos</span><p id="par0205" class="elsevierStylePara elsevierViewall">Al Grupo Cohorte DAMA&#58; Xavier Bargall&#243; &#40;Hospital Cl&#237;nic de Barcelona&#41;&#44; Montserrat Dom&#232;nech &#40;Asociaci&#243;n de Mujeres con C&#225;ncer de Mama &#91;&#193;gata&#93;&#41;&#44; Mart&#237;n Espinosa-Bravo &#40;Hospital Universitari Vall d&#8217;Hebron&#41;&#44; Jaume Grau &#40;Hospital Cl&#237;nic de Barcelona&#41;&#44; Francesc Maci&#224; &#40;Parc de Salut Mar&#44; Institut Municipal d&#8217;Investigacions M&#232;diques &#91;IMIM&#93;&#41;&#44; Rafael Manzanera &#40;MC Mutual M&#232;dica&#41;&#44; Margarida Pla &#40;Universitat de Barcelona&#41;&#44; Rosa Puigpin&#243;s-Riera &#40;Ag&#232;ncia de Salut P&#250;blica de Barcelona&#44; CIBER de Epidemiolog&#237;a y Salud P&#250;blica &#91;CIBERESP&#93;&#41;&#44; Institut de Recerca Sant Pau &#91;IIB Sant Pau&#93;&#41;&#59; M&#46; Jes&#250;s Quintana &#40;CIBERESP&#59; IIB Saint&#46; Pau&#59; Hospital de la Sta&#46; Creu i Sant Pau&#41;&#44; Maria Sala &#40;IMIM&#59; Universitat Aut&#242;noma de Barcelona&#59; Red de Investigaci&#243;n en Servicios de Salud&#41;&#59; y Eul&#224;lia Vidal &#40;Facultat de Ci&#232;ncies de la Salut Blanquerna - Universitat Ram&#243;n Llull&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0210" class="elsevierStylePara elsevierViewall">Ministerio de Sanidad&#44; Instituto de Salud Carlos III - Subdirecci&#243;n General de Evaluaci&#243;n y Fomento de la Investigaci&#243;n&#44; Plan Estatal de Investigaci&#243;n Cient&#237;fica y T&#233;cnica y de Innovaci&#243;n 2013-2016&#44; cofinanciado por el Fondo Europeo de Desarrollo Regional &#40;FEDER&#41;&#44; n&#250;mero de proyecto PI13&#47;01977&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0215" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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            0 => "C&#225;ncer de mama"
            1 => "Cribado de c&#225;ncer"
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            1 => "Cancer screening"
            2 => "Diagnostic route"
            3 => "Adverse effects"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir y analizar&#44; seg&#250;n la v&#237;a diagn&#243;stica&#44; las caracter&#237;sticas de los tumores de c&#225;ncer de mama&#46; Se analizan los efectos adversos de los tratamientos recibidos y la utilizaci&#243;n de terapias no convencionales para paliarlos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dise&#241;o descriptivo anidado en cohorte mixta &#40;Cohorte DAMA&#41;&#46; La variable dependiente fue la v&#237;a diagn&#243;stica del c&#225;ncer de mama&#46; Las variables independientes fueron la edad&#44; el &#237;ndice de masa corporal&#44; la clase social&#44; con renta familiar disponible&#44; el tipo de tumor&#44; el grado histol&#243;gico&#44; el estadio tumoral&#44; las recidivas&#44; el tratamiento&#44; los efectos adversos de los tratamientos y las terapias no convencionales&#46; Se realizaron an&#225;lisis descriptivos bivariados y se ajustaron modelos de regresi&#243;n univariados y multivariados&#44; y se hicieron representaciones gr&#225;ficas de la frecuentaci&#243;n de terapias no convencionales&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Existen diferencias en las caracter&#237;sticas de los tumores y en el impacto de los efectos adversos derivados de los tratamientos&#46; Las pacientes diagnosticadas por cribado fueron de mayor edad y de clase social alta&#44; presentaron un mayor porcentaje de tumores de grado I histol&#243;gico&#44; estadios iniciales&#44; menos recidivas y efectos adversos debidos al tratamiento&#44; aunque este no fuera distinto en el grupo de cribado respecto al resto&#46; Tambi&#233;n hubo un menor uso de terapias no convencionales&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los resultados indican que la implantaci&#243;n de programas de cribado aumenta la posibilidad de detectar tumores en etapas iniciales y con terapias con menos efectos adversos&#59; en consecuencia&#44; con menor necesidad de recurrir a terapias no convencionales&#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 describe and analyze the characteristics of breast cancer tumours according to the diagnostic pathway&#46; We analyse the adverse effects of the treatments and the use of unconventional therapies in order to alleviate them&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Descriptive design nested in a mixed cohort &#40;Cohort DAMA&#41;&#46; The dependent variable was the route to diagnosis of breast cancer&#46; The independent variables were age&#44; body mass index&#44; social class&#44; disposable family income&#44; type of tumour&#44; histological degree&#44; tumour stage&#44; recurrences&#44; treatment&#44; adverse effects derived from treatments and unconventional therapies&#46; Bivariate descriptive analyses were performed and univariate and multivariate regression models were adjusted&#59; and graphic representations of the unconventional therapies&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">There are differences in the characteristics of the tumours&#44; and the impact of the adverse effects derived from the treatments&#46; The patients diagnosed by screening were older&#44; from a high social class&#44; had a higher percentage of tumours of grade I differentiation&#44; initial stages&#44; fewer recurrences and fewer adverse effects due to treatment&#44; although this was not different in the screening group compared to the rest&#46; There was also less use of unconventional therapies&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The results indicate that the implementation of screening programmes increases the possibility of detecting tumours in initial stages and with therapies with fewer adverse effects&#46; As a result&#44; there is less need to resort to unconventional therapies&#46;</p></span>"
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          "leyenda" => "<p id="spar0043" class="elsevierStyleSimplePara elsevierViewall">IC95&#37;&#58; intervalo de confianza del 95&#37;&#59; No-PDPCM&#58; revisi&#243;n habitual por su m&#233;dico&#44; por acudir tras notarse un bulto&#44; por seguimiento cl&#237;nico de factores de riesgo&#44; u otras formas de diagn&#243;stico por signos o s&#237;ntomas&#59; NS&#47;NC&#58; no sabe&#47;No contesta&#59; ORa&#58; <span class="elsevierStyleItalic">odds ratio</span> ajustada&#59; ORc&#58; <span class="elsevierStyleItalic">odds ratio</span> cruda&#59; PDPCM&#58; programa de detecci&#243;n precoz de c&#225;ncer de mama&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase no manual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">108&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">30&#44;9&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">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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
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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>Grado II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;8&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">1&#44;77<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;1&#44;28-2&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;60<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;1&#44;07-2&#44;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No aplicable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;0&#44;25-1&#44;35&#41;&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"><span class="elsevierStyleItalic">Estadio del tumor</span>&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"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&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
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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>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;9&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">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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"><span class="elsevierStyleHsp" style=""></span>I&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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&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\ttop\n
                  \t\t\t\t">S&#237;&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"><span class="elsevierStyleItalic">Diarrea-estre&#241;imiento</span>&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">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S&#237;&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  " align="" valign="\n
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                  \t\t\t\t">&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;1&#44;10-1&#44;87&#41;&nbsp;\t\t\t\t\t\t\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">Alteraciones del gusto</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="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\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">No&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&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  " align="left" valign="\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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#218;lceras</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="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">549 &#40;71&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;88<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;42-2&#44;49&#41;&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="elsevierStyleItalic">Alteraciones ungueales</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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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">No&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
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                  \t\t\t\t">343 &#40;68&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">422 &#40;55&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\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">S&#237;&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
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                  \t\t\t\t">156 &#40;31&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">345 &#40;45&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&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">1&#44;80<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;1&#44;42-2&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Defensas</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="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\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">No&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">425 &#40;85&#44;2&#41;&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">593 &#40;77&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">S&#237;&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">74 &#40;14&#44;8&#41;&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">174 &#40;22&#44;7&#41;&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="" valign="\n
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                  \t\t\t\t">&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">1&#44;69<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></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">&#40;1&#44;25-2&#44;27&#41;&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="elsevierStyleBold">Radioterapia &#40;s&#237; vs&#46; no&#41;</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
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                  \t\t\t\t">393 &#40;78&#44;8&#41;&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">0&#44;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Descamaci&#243;n de la piel</span>&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">No&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
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                  \t\t\t\t">205 &#40;48&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">323 &#40;50&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&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">215 &#40;51&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">322 &#40;49&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;95&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">&#40;0&#44;74-1&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cansancio</span>&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">No&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
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                  \t\t\t\t">223 &#40;44&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">361 &#40;47&#44;1&#41;&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">S&#237;&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">276 &#40;55&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">406 &#40;52&#44;9&#41;&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Hormonoterapia &#40;s&#237; vs&#46; no&#41;</span>&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">No&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">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">215 &#40;43&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Osteoporosis</span>&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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">413 &#40;82&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">599 &#40;78&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No&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">No&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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">469 &#40;94&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">694 &#40;90&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;64<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Naturista&#47;natur&#243;pata</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">462 &#40;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">710 &#40;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#191;Ha recibido alg&#250;n tratamiento&#63;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\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">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">528 &#40;95&#44;0&#41;&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">21 &#40;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Homeopat&#237;a</span>&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">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">455 &#40;91&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">683 &#40;89&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#40;11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;27&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">&#40;0&#44;87-1&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Acupuntura</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&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">No&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
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                  \t\t\t\t">467 &#40;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">719 &#40;93&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&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">32 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;97&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">&#40;0&#44;61-1&#44;55&#41;&nbsp;\t\t\t\t\t\t\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">Plantas medicinales</span>&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1393&nbsp;\t\t\t\t\t\t\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">No&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
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                  \t\t\t\t">459 &#40;92&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">685 &#40;89&#44;3&#41;&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">474 &#40;95&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">718 &#40;93&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Reiki</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" 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">No&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
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                  \t\t\t\t">474 &#40;95&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">695 &#40;90&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">72 &#40;9&#44;4&#41;&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</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">T&#233;cnicas de relajaci&#243;n</span>&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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&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
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                  \t\t\t\t">457 &#40;91&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">656 &#40;85&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&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">42 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">111 &#40;14&#44;5&#41;&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">1&#44;84<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></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
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                  \t\t\t\t">&#40;1&#44;27-2&#44;68&#41;&nbsp;\t\t\t\t\t\t\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">Visualizaci&#243;n</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="" valign="\n
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                  \t\t\t\t">0&#44;590&nbsp;\t\t\t\t\t\t\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">No&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">485 &#40;97&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">740 &#40;96&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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