Health Insurance) (14.3%), and Essalud (Social Heath
Security) (12.8%) (17). Following the launch of Plan
Ezperanza (Table 1), out-of-pocket expenses have decreased
from 58.1% (2009) to 7.33% (2014) and patients associated
with the comprehensive public health insurance programme
(SIS) have increased from 17.2% (2009) to 64.31% (2014) (16,
28).
Whilst cancer is considered to be a preventable and
curable condition if detected early, for cultural, economic and
social reasons 85% of detected cases are diagnosed in
advanced stages. (6, 8).
In 2004, Peru lost 377,000 years of productive life due to
deaths from cancer, representing an economic loss of
approximately US$ 900 million annually. Stomach, cervical,
breast, melanoma, prostate, lung, colorectal, lymphoma,
leukemia and liver cancer accounted for 68.4% of total
productive years of life lost, with haematological
malignancies (leukemia, multiple myeloma and lymphoma)
together accounting for 25.604 and 21.610 lost productive
life years in men and women respectively (18, 19). These
cancers pose the greatest burden of disease and are
regarded as high-cost illnesses (FISSAL) (20).
In the public health system 75% of cancer cases are
diagnosed at the advanced stage versus 20% in the private
health system with attendant consequence upon survival. Of
those cases, 65% are diagnosed in women. Mortality rates
are higher in women than men, due to cervical cancer and
breast cancer; and in older adults compared to younger
people. These biological, social and cultural disparities
highlight the need for targeted action (6, 15, 21).
Cancer in Peru: Health services
The supply of health services for cancer care in Peru is
centralized in the capital (Lima). Service distribution
nationally is unequal and requires the strengthening of
health services and levels of care through distributed
provider networks to enhance the prevention and control of
cancer (10, 21).
Since 2011, the Budget Programme of Cancer Prevention
and Control has enacted reforms in the Peruvian public
finances that prioritize financial resources for interventions
for primary and secondary prevention; the identification of
new cases has been increased, generating the need to
expand access and coverage for cancer treatment; and the
importance of strengthening the response capacity of health
services nationally has been recognized through prioritizing
the provision of services by type of most common cancers,
vulnerable geographic areas, population density and number
of related human resources for prevention and control of
cancer (17).
To further enhance population cancer control, the
Peruvian government declared its support for a national
comprehensive cancer care plan with improved access to
cancer services in November 2012 (Plan Esperanza). Its
specific objectives are to prevent the development of cancer
in the 12 million poor and extremely poor people through
the promotion, prevention and early detection of cancer; as
well as providing timely, comprehensive, quality treatment
and care for all patients through strengthened services in
the public sector (6, 10). Thus, despite a lower proportion of
health expenditure in Peru compared to the average health
expenditure as a proportion of GDP in Latin American
countries, the intent is to create a comprehensive coverage
package that offers pluralistic and equitable populationbased
cancer control.
Cancer control in Peru: INEN and the global health
community
International collaboration has been instrumental in
mobilizing policies and actions for the prevention and
REGIONAL INITIATIVES
CANCER CONTROL 2015 131
Year 2009 2010 2011 2012 2013 2014
SIS Cobertura Básica SIS Y/O Cobertura total
SIS (FISSAL + SIS) 17.20% 23.10% 31.40% 38.40% 63.70% 64.31%
HOSPITAL + SOCIAL 58.10% 51.70% 42.70% 34.00% 8.20% 7.33%
Total 75.30% 74.80% 74.10% 72.40% 71.90% 71.64%
(Gasto de Bolsillo +
Fondo Ayunda INEN) 2010 2011
Table 1: Total patients in INEN from 2009 to 2014 from low-income backgrounds