By the time Archana Lal, a government midwife in Chandigarh, India, consulted a doctor in August, she had been experiencing constant pain and discharge in her left breast for some months. It was only when it became unbearable that her husband dragged her to see a doctor.
She had thought of seeing a doctor, but the idea of removing her clothes to be examined was unthinkable. Like millions of Indian women, Lal has been culturally conditioned always to be modest.
There are millions of women in rural areas who don't remove their clothes even while making love with their husbands. So powerful is the cultural conditioning against nudity, or 'wantonness', that they have sex still wearing their sari blouses and petticoats under the saris.
Even many educated women in the cities put off having mammograms or ultrasound scans because of acute embarrassment over taking off their clothes and being examined by a male doctor or technician.
'By the time I saw her, the cancer had spread to her lymph nodes,' said Chandigarh oncologist Dr Rajeev Bedi. 'Patients generally present in advanced stages when it's too late to help them.'
Cultural attitudes such as 'shyness' that can play a part in determining the incidence of cancer in a country are some of the factors that will be studied as part of the largest cancer study ever to be undertaken in India. Nine leading cancer centres in the country will collaborate with Oxford University on the study, called Indox.