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Peru, in South America, is a developing country according to the United Nations, with a population of 33.6 million inhabitants and a rugged geography. Administration of health services is often limited for the population residing in remote places. Lima, the capital city, has 9.6 million inhabitants, and therefore two thirds of the population live in the provinces.
The Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, is the national governing body for cancer. In 2021, it registered 26 940 gynecological visits, mostly to patients affiliated with the Seguro Integral de Salud (SIS) (ie, at minimal cost to the patient, otherwise the cost is US$5.05); the wait from the request to completion of the consultation was 1–7 days. In the same year, 665 major surgeries and 402 procedures for gynecological cancer were registered, with adjuvant treatment available (eg, chemotherapy, radiotherapy, brachytherapy, immunotherapy, and hormone therapy).1
In 2019, the INEN tower was opened (Figure 1), where procedures are performed in large volume, and 13 000 new cases of cancer were treated and almost half were from the provinces. Therefore, the strategy to fight cancer consisted of decentralization, a planning that was contemplated years before with the creation of the Institutos Regionales de Enfermedades Neoplásicas (IRENes) in strategic cities in the north, center, and south of Peru (Figure 2).
The Instituto Regional de Enfermedades Neoplásicas (IREN NORTE), Trujillo (1 million inhabitants in 2022), has served the northern macro region since 2007. In 2021, it registered 7200 gynecological visits, mostly covered by the SIS (otherwise the patient pays US$4.29); the request to completion wait for the consultation was 1-3 days. In 2021, IREN NORTE registered 113 major gynecological surgeries, with adjuvant treatment.2
IREN SUR, Arequipa (1.3 million inhabitants in 2022), has been serving the southern macro region since 2008. In 2021, it had 2466 gynecological services covered mostly by the SIS (otherwise the patient pays US$5.8); the waiting time from request to carrying out care was 3–5 days. In 2021, there were 212 major gynecological surgeries, with adjuvant treatment.3
IREN CENTRO, Concepción-Junín (6878 inhabitants in 2022), has served the central macro region since 2020. In 2021, it registered 4389 gynecological visits, mostly covered by the SIS (otherwise the patient pays US$5.05); the request to completion wait for the consultation was 1–7 days. In 2021, IREN CENTRO registered 132 major gynecological surgeries, with adjuvant treatment.4
Finally, the IREN ORIENTAL project is already underway and will include the Amazonian regions of the country, continuing with the decentralization initiated by the rest of the IRENes.
In May 2008, when the IRENs were not fully operational, 2680 gynecological services were provided at INEN, of which 22.6% patients came from the north, 11.2% from the south, and 7.8% from the center. In contrast, by May 2022, 2967 had care in INEN and only 18.1% came from the north, 10.7% from the south, and 5.4% from the center. This reflects the impact of the creation of IRENs in the control and management of cancer in favor of patients and gynecological oncologists, constituting decentralization as the main weapon against cancer in a country with medium resources.
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Contributors All authors contribute equally.
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Competing interests None declared.
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