In 1945, physicians in India reported a new type of skin cancer, marked by thickened scars that could progress malignant lesions. They termed it “dhoti cancer”, the dhoti being a traditional male clothing item in India which is wrapped around the waist. As it turns out, the sari, the female equivalent, could be putting millions of women at increased cancer risk.

A sari (or saree) is a traditional garment worn by women in South Asia, especially in India, Bangladesh, and Sri Lanka. It’s essentially a long, unstitched piece of fabric, typically measuring 5 to 9 meters, draped around the body in various styles. The sari is usually wrapped around the waist, with one end draped over the shoulder, often revealing a midriff. It is worn with a fitted blouse (choli) and an underskirt (petticoat).

Saris come in a wide range of colors, fabrics, and designs, linked to the cultural heritage and social identity of the wearer, but they are all secured over an ankle-length skirt (a petticoat). The petticoat is usually tied very tightly around the waist with a cord — and herein lies the problem.

A 2014 case study presented a “rare” type of cancer caused by this garment. Now, researchers say this problem could be more widespread.

Constant pressure

The study was led by Kaveri Russia, from the Jawaharlal Nehru Medical College in India. The team argues that the constant pressure causes a wound that never has time to heal, and in time, can develop into cancer.

“Constant pressure at the waist often leads to cutaneous atrophy, which ultimately breaks down to form an erosion or an ulcer. The ulcer at this site does not heal entirely due to ongoing pressure from tight clothing. A chronic non-healing wound results, which may develop malignant change,” the study authors write.

The first case the researchers describe comes from a 70-year-old woman who had a painful skin ulcer that wouldn’t heal. The skin in the area had lost its pigmentation, and the case was confirmed as a type of cancer. A second study found a similar problem in a different woman in her 60s.

They both wore the sari petticoat tightly, almost every day, for decades. It’s this tightness that is most likely causing the problem, the researchers note in the study.

“In the literature, these skin lesions, including malignant transformation, have been described as ‘saree cancers’, but it is the tightness of the cord tied around the waist that results in chronic inflammation that may result in malignant transformation.”

Saris are fine — just don’t wear them so tight

Researchers mention that it’s the petticoat, the undergarment that seems to be causing the problem. So, it’s not that you shouldn’t wear a sari, it’s that if the petticoat is too tight and you wear it all the time, it can become a problem. They even call it ‘petticoat’ cancer rather than sari cancer.

The team also notes that the process through which these cancers occur is not perfectly understood. More research is required to assess the risk properly

“The exact process by which chronic ulcers or wounds become malignant is unknown, although many theories have been proposed,” they write. “Every cutaneous lesion that is continuously irritated (chronically inflamed) has been shown to have a higher risk of developing malignant transformation.” 

It’s not clear how significant the risk posed by the sari is. The vast majority of skin cancer cells originate from other causes. However, researchers say this is something sari (and dhoti) wearers should be aware of.

The patients also say they hope their journey will inspire others to pay more attention to this issue.

“This has been a psychologically and physically taxing journey. It shows the importance of paying attention to chronic skin changes and seeking medical advice early. I hope my story will raise awareness among women about the potential health risks associated with traditional clothing practices and encourage timely medical consultation for unusual skin conditions,” noted one of the patients.

The study was published in the British Medical Journal.