Understanding 'Petticoat Cancer': The Rare Risk for Saree-Wearing Women in India

The saree is a cherished symbol of India’s cultural heritage, worn by millions of women across the country for generations. This traditional garment is synonymous with grace, beauty, and pride, finding its way into almost every wardrobe. However, recent findings reveal an unexpected health risk tied to the way many women wear sarees—specifically, the tight petticoat strings that can lead to skin disorders and, in rare cases, a type of cancer now dubbed "petticoat cancer" or "saree cancer."

A study published in BMJ Case Reports sheds light on this little-known condition, warning that the prolonged pressure of a tightly tied saree underskirt could lead to skin problems, which in extreme cases can develop into a rare form of cancer. This insight has led doctors to advise caution among saree wearers, especially those who frequently tie their sarees tightly around the waist.

What is Petticoat Cancer?

"Petticoat cancer," medically known as Marjolin’s ulcers, refers to skin ulcers and lesions that develop after years of wearing sarees with tightly tied petticoats. This condition primarily affects women who regularly wear sarees with snug petticoat strings around the waist. These strings, tied at the same spot for extended periods, can eventually cause skin irritation, which can escalate to ulcers and potentially malignancy.

Dr. Darshana Rane, a consultant in medical oncology at HCG Cancer Centre in Borivali, Mumbai, explains, “Saree cancer is a unique condition found in women who wear sarees daily, typically occurring around the waistline. When the petticoat string is consistently tied tightly, it can lead to dermatoses or skin irritation, sometimes forming Marjolin’s ulcers, and in very rare cases, leading to cancer.”

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How Does Petticoat Cancer Develop?

The pressure from a tightly tied petticoat string over the years can thin the skin and cause continuous friction. This irritation gradually breaks down the skin’s natural barrier, leading to erosion and ulceration. In some cases, these ulcers can develop into squamous cell carcinoma, a type of skin cancer. Cases reported in India include elderly women who have worn sarees daily for decades and unknowingly developed sores or skin ulcers that later became cancerous.

One such case involved a 70-year-old woman who noticed an ulcer on her right side, accompanied by pigmentation. Doctors diagnosed her with squamous cell carcinoma, attributing the cause to the persistent pressure from her petticoat string. She shared, “I wore a tightly wrapped saree for decades, unaware of the potential health risks. What started as a minor skin irritation turned into a painful ulcer and ultimately was diagnosed as skin cancer.”

More Reported Cases and Their Experiences

While “petticoat cancer” is a rare condition, there have been numerous cases reported across India. In Chennai, Bengaluru, and Mumbai, doctors have encountered similar instances where elderly women, who had worn tightly tied sarees daily, developed skin ulcers around the waistline that turned cancerous.

For instance, one woman in her late sixties from Mumbai wore a traditional saree style called "lugda" tied directly at the waist without a petticoat. Over time, this created an ulcer that spread to her lymph nodes, causing severe physical and emotional distress. Her experience has highlighted the importance of early medical intervention for unusual skin changes. "This experience has been physically and emotionally taxing. I hope my story encourages others to seek medical advice if they notice unusual skin changes," she shared.

Interestingly, this condition is not limited to women. Men who wear traditional garments like dhotis, which are tied similarly around the waist, may also be at risk. Renowned pathologist Vasant Khanolkar encountered a comparable condition in eight men and termed it “dhoti cancer.”

Why Saree Strings Cause Issues and Not Belts

Some experts suggest that the reason tightly tied saree strings lead to skin issues and not belts is due to the difference in width. Dr. Madke, a dermatologist, explains, “The saree string is much thinner than a belt, leading to more intense pressure on a smaller area. This constant, concentrated pressure can damage the skin over time, leading to the formation of ulcers.” Additionally, the risk is likely higher in hot, humid climates where the combination of sweat and dust can exacerbate irritation around the waistline.

Recognizing the Early Signs of Petticoat Cancer

Early symptoms of petticoat cancer can be subtle, which is why they often go unnoticed, particularly in rural areas where access to healthcare services may be limited. The signs to look out for include:

Persistent skin irritation around the waistline

Changes in pigmentation or skin texture in the affected area

Mild scaling, itching, or scratching

Non-healing sores or ulcers around the waist

Dr. Rane notes that the Indian climate, especially in rural areas, can intensify the irritation caused by a tightly tied saree string. Dust and sweat accumulate around the waist area, worsening the irritation. Unfortunately, women in these regions may not be able to access healthcare services or may delay seeking help until the symptoms become severe.

Preventing Petticoat Cancer

Preventing petticoat cancer begins with simple adjustments to reduce pressure and friction on the skin. Here are some recommendations:

1. Avoid Tying Petticoats Too Tightly: Ensuring a comfortable fit rather than a snug one can help prevent unnecessary skin pressure.

2. Opt for a Broader Waistband: Petticoats with a wider waistband distribute pressure more evenly, which reduces the chance of skin irritation. Choosing soft, breathable fabrics for petticoats also helps keep the waist area comfortable.

3. Change the Tying Position: Occasionally altering the height at which the petticoat is tied can prevent repeated pressure on the same area. This helps give certain parts of the skin a break, reducing the chance of long-term damage.

4. Maintain Good Hygiene: Regularly clean the waist area to remove sweat and dust that may accumulate, especially for those working outdoors or in humid environments. Ensuring the skin is dry and free from sweat buildup can also prevent irritation.

5. Check for Early Signs of Skin Changes: Regularly inspect the waist area for any unusual skin changes. If you notice changes in pigmentation, skin texture, or experience persistent irritation, consult a healthcare provider sooner rather than later.

The Larger Implications

The risk of petticoat cancer highlights an essential need for greater awareness and education about traditional clothing's potential health implications. While sarees and other cultural garments hold tremendous personal and societal value, it’s essential to understand the potential health risks associated with how they’re worn.

In particular, raising awareness about this condition can help individuals in rural areas, where the combination of cultural norms and limited healthcare access makes them more vulnerable. Simple preventive steps can save individuals from long-term discomfort and health risks.

For healthcare providers, petticoat cancer underscores the importance of looking beyond common ailments, especially when treating women who present with skin issues in the abdominal area. Prompt diagnosis and treatment of skin conditions can prevent their progression into more severe illnesses.

Conclusion

Petticoat cancer is a rare but significant health risk associated with prolonged and repeated pressure from saree strings tied around the waist. While the saree is an iconic garment cherished by millions, simple precautions—like adjusting how tightly petticoats are tied, choosing broader waistbands, and paying attention to skin health—can help saree-wearers protect themselves.

In summary, awareness and proactive care are key. By staying mindful of these potential issues, saree-wearers can continue to embrace the beauty and elegance of their traditional attire without compromising their health.