A letter to every woman

October 20, 2016

Dear wondrous woman,

You are the reason for my existence, the entire human race springs forth from the creative burst of your womb. You have been the creator and sustainer of the family and human society, blessed is your body. Your breasts are a tool of attraction and nutrition, your assets in this experience of starting and raising a family. The aesthetic curve of female form and the source of sustenance for your beloved child as you nurse a small struggling life with the milk of your bosom.

However, with great privilege there can be a problem . Your breasts are also the commonest site of cancerous growth among women across the world and in India. The same growth required to produce its unique nourishing fluid, when going out of control, produces a malignant tumour that disobediently spreads through your breast and body, causing destruction and death. A cruel twist of fate can cut short a young life as yours.

Would you not rather suckle your infants than lose your breast on the surgeons table?
Would you not rather revel in their naughty pranks than be harassed by poisonous therapies?
Would you not rather bask in the love of your spouse than lay bare in the radiation room?

Then awake, arise and be aware of the risks you may be harbouring in your frame and keep those tissues healthy as best you can. Try to go with the flow of life as you balance the varying demands of family and work. Don’t delay your children too long, the jobs and career can learn to cope with them. Breast feed tenderly your infants for 6 months to nine at least. Keep active wherever you are, there is no substitute for exercise be it walking, running, cycling, swimming, dance or sport. The aerobic activities tone your body and tune up your immune systems that keep a check on you cells’ growth. Eat healthy most days with fruit and veggies. Use hormonal pills very sparingly and discuss this with you doctor. Say no, never to tobacco. Keep off the alcohol as best you can – an occasional drink, for celebration permitted.

If a close relative has had a brush with the dreaded disease, you will need to assess your own risk. Check it out with your doctor or an online calculator. If your risk is significant, a regular check with your surgeon is time well spent. A mammogram may be used to have a closer look.

Two Journeys by Usha Jesudasan
Dr. MJ Paul, Surgeon and Professor, CMC Vellore shares more of his thoughts in 'Two Journeys' - by author and cancer survivor Usha Jesudasan

In spite of your best efforts, cancer does strike like a mysterious plague. Be aware of your body and breasts, get used to the feel of the tissue, the cadence of change with your menstrual cycle; then you can recognize when there is a misstep! Could the small lump, the tethered nipple, the armpit lump, the dull pain felt recently be a sign of the disease? Have a good look in the mirror, don’t hesitate to feel yourself and check your findings with a doctor to make sure. For cancer comes in varied forms, one must be alert to catch the fledgling growth and strike early and successfully to survive the beast.


Take heart my dear; for with all these measures, you can possibly change your future, those orbs will be a source of joy and not a sign of misery.

With best wishes,

Dr. M J Paul, Professor, Endocrine Surgery, CMC Vellore


  1. Manorama Hiteshi

    Wonderful message of wisdom let it spread far and wide

    • Manorama Hiteshi

      Good advice

    • Manorama Hiteshi

      Excellent advice

  2. Yuvaraj Davidson

    Very well written, Paul!

    YD and Denny

  3. Meena

    Dr M J Paul,
    The message is well intentioned, but I’d like to ask if there are any conclusive reports linking marital status or child bearing to breast cancer. Because if there isn’t, I think it’s time we stop pushing women into getting married or getting a child so they can prevent cancer. It has become a norm these days for many doctors to blame most health issues on being unmarried, although married women complain about the same health issues. Fitness, diet changes, smoking habits are mentioned here, but stressing mostly on child bearing is very misleading (because then there would be a a vast difference between married and unmarried cancer patients).

    • M J Paul

      Dear Meena,
      I understand your concerns and a general short exhortation of this type can have unintended implied messages.
      The science from epidemiological studies on large populations does show the increased incidence of cancer in nulliparous women. Having a child reduces the incidence by 25% for the luminal subtype which is the most common but also the most treatable type. Advanced age at first birth and not breast feeding are also conclusively significant risk factors. These studies are on large populations.
      I think many more important issues will operate when a particular woman remains unmarried or childless and this breast cancer risk will be of secondary concern to so many other concerns.The exhortation implied is to work harder on the other modifiable factors. Can you suggest a modification to address your concern? Based on our social parameters, for more than 90% of women, the family and children will be prime concerns, hence the relevant stress on those factors.

      The evidence is quoted below from a recent overview.

      Reproductive behaviors and risk of developing breast cancer according to tumor subtype: A systematic review and meta-analysis of epidemiological studies
      Cancer Treat Rev. 2016 Sep;49:65-76. doi: 10.1016/j.ctrv.2016.07.006. Epub 2016 Jul 29
      Matteo Lambertinia, b, Luigi Santoroc, Lucia Del Mastrod, Bastien Nguyene, Luca Livraghif, Donatella Ugolinig, Fedro A. Peccatorih, Hatem A. Azi
      This meta-analysis evaluated 15 studies, including 21,941 breast cancer patients and 864,177 controls. Parity was associated with a 25% reduced risk of developing luminal subtype (pOR 0.75; 95% CI, 0.70–0.81; p < 0.0001). Advanced age at first birth was associated with an increased risk of developing luminal subtype (pOR 1.15; 95% CI, 1.00–1.32; p = 0.05). Ever breastfeeding was associated with a reduced risk of developing both luminal (pOR 0.77; 95% CI, 0.66–0.88; p = 0.003) and triple-negative (pOR 0.79, 95% CI, 0.66–0.94; p = 0.01) subtypes.
      The reproductive behaviors impact the risk of developing breast cancer but this varies according to subtype.

  4. M J Paul

    One has to understand that studies are done on large populations and the risk to the induvidual may not seem as daunting as the overall percentages. For instance though 25% difference sounds large, to a single childless woman the risk translates to a change from 1 in 400 to 1 in 300 chance of getting the disease compared to a woman with children. Odds of 1 n 300 is not something one would normally fear and worry about, but advisable to make a note and change some of the above lifestyle concerns that are practically faaesible.
    I am adding a line to the piece after the advice to breast feed to address concerns of childless/unmarried women – “If life finds you single, no reason to fear – there is still a lot you can do to keep your risk lowered, dear.’

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