control of cancer in Peru. The American Cancer Society, the
International Union Against Cancer and the National
Institute of Cancer in the United States have promoted a
multisectoral coalition against cancer with INEN with a view
of having Peru free from advanced cancer through cultural
and educational development and access to quality services
for health improvement and cancer control by 2016 -
however, no budget or financial resources were assigned for
this purpose (7). Notwithstanding, relationships were
created, including active and responsible civil society
participation (23).
In July 2011, the Network of Cancer Institutes
(RINC/UNASUR) was established in Rio de Janeiro. In
November 2011, a meeting to strengthen systems for
monitoring and evaluating the Plan Esperanza was held in
Lima (9, 24).
In September 2011, the political declaration of the high
level meeting of the United Nations General Assembly on
the Prevention and Control of Noncommunicable Diseases
was issued which recognized noncommunicable diseases,
including cancer, as a challenge for socio-economic
development, environmental sustainability and poverty
reduction (12, 25).
In June 2012, during the Rio + 20 Conference on
Sustainable Development in Brazil, the burden of
noncommunicable diseases worldwide was recognized as
one of the main obstacles to sustainable development (10,
24, 25).
In October 2012, under the Project for a Global Plan of
Action for the Prevention and Control of Noncommunicable
Diseases 2013-2020, WHO stated that the prevention of
NCDs such as cancer, is a precondition to achieve sustainable
human development and interdependent social, economic
and environmental dimensions of development (12, 26).
In 2012, INEN partnered with the South West Oncology
Group (SWOG) and the Cancer Research Network (USLACRN)
sponsored by the NIH/NCI (US) in scientific
cooperation projects and software development.
Cancer in Peru: INEN and policies for prevention
and control
The National Cancer Institute of Peru was created in 1939,
changed name and was reorganized in 1952 with Dr
Eduardo Cáceres Graziani (father of Peruvian oncology)
assuming leadership of the National Institute of Neoplastic
Diseases (INEN) resulting in significant interest in cancer
control, valuable scientific contributions to global health and
the development of specialty education that began with the
medical residency in oncology (12).
REGIONAL INITIATIVES
132 CANCER CONTROL 2015
In 2004, Law Nº 28343 - 2004 established the national
interest in, and public necessity for, the decentralization of
oncology services and macro-regional offices linked to the
network of INEN The North IREN (Regional Institute for
Neoplastic Diseases) was established in La Libertad (Trujillo,
2007) and South IREN in Arequipa (2009). Continuing
expansion to provide highly specialized services for cancer
control throughout the country is currently under
construction in Huancayo (Central Region, Concepcion) and
in the East region of Loreto (Iquitos, the Amazon IREN). Also,
since 2011, INEN has promoted the implementation of 21
cancer prevention offices (primary and secondary
prevention) and 13 cancer units in general hospitals (22, 29).
Given the existing multiplicity of public and private health
providers, the fragmentation of prevention and cancer
control activities, limited coverage of prevention and
comprehensive cancer care and no measurable or evaluable
interventions, it was imperative that INEN gained the
functions and authority of the Regulatory Agency of Cancer
in Peru. In 2006, INEN received the designation of
"Decentralized Public Agency " with consolidation in 2007 as
a public executing agency for the health sector with
administrative and financial autonomy, in charge of the
development of public policies and the national leadership of
cancer prevention and control in coordination with the
Ministry of Health (MINSA). (Law 28748 and Supreme
Decree 001-2007) (30,31).
In April 2006 the General Law for the Prevention and
Control of Consumption Risks of Tobacco (Law 28705) was
enacted, which was essential to implement measures for
promotion about and prevention of exposure to tobacco
smoke, and the subsequent important initiative to decrease
the number of new smokers by ENDES (2012) (32, 33).
In 2007, the National Plan for Strengthening the
Prevention and Control of Cancer in Peru was approved
(34). The Concerted Health Plan was approved in 2007 with
the priority of decreasing mortality from cervical cancer,
breast, prostate, lung and stomach cancer (35). The
Comprehensive Health Insurance Plan that gives financing
conditions for the treatment of cervical cancer, breast,
colon, stomach and prostate, with coverage and limited
access was approved in 2009.
Cancer in Peru: Comprehensive Health Insurance
(SIS)
Peru, with approximately 30 million inhabitants, is engaged
in the process of health reform (30). The public sector serves
95% of the population with the remaining 5% accessing
private health care. Of the 95% public sector service, 75% of