A breast cancer support campaign shows the power of letters

Erika Mailman

THE WASHINGTON POST – A single card, written by a stranger, became an important touchstone for the recipient, a woman who had been diagnosed with breast cancer. The woman kept the card on her nightstand and read it every night before bed. She brought it with her to every appointment.

“That was the only card she got,” said Gina Mulligan, founder of Girls Love Mail, a non-profit that sends handwritten cards and letters of support to breast cancer patients across the United States (US).

Such is the power of one missive. Consider that multiplied across 145,000 letters, the number forwarded since the charity began in 2011.

In 2009, Mulligan, who lives in Folsom, California, US was writing a novel in the form of a series of letters (later published as From Across the Room), when she received a diagnosis of breast cancer. She was flooded with more than 200 cards and letters of support, mostly from people she didn’t know but whom she suspects were friends of her colleagues.

“It was very strange, and I was sensitive to it because of my research with letters. I realised how special they were.”

Volunteers for Girls Love Mail read incoming mail. PHOTOS: THE WASHINGTON POST
A box of letters from St Scholastica Academy, an all-girl high school in Convington, Louisiana, where students wrote 792 letters in one day
A Girls Love Mail letter with envelope
Author Gina Mulligan, founder of Girls Love Mail, at her dining room table beside a basket filled with the letters she received during her treatment

While Mulligan was receiving the letters, she was undergoing six weeks of daily radiation treatment and seeing the same women in the prep room. “Some were there by themselves without family or friends,” she said. “We all think everyone has a support system, but that’s not true.”

Once Mulligan emerged from treatment – at age 51, she is now 10 years cancer-free – she mulled over how to help others. She was thinking about the various campaigns to support US military troops and had a lightbulb moment – she could organise letters for breast cancer warriors. “Letters are tangible; you can reread them,” Mulligan said. “You get that feeling of not being alone, of being cared for.”

Here’s how it works. People send handwritten cards or letters to Girls Love Mail, where Mulligan and volunteers screen the letters. They then send them on to 165 cancer centres across the country, for distribution by nurse navigators. Centres that deal with metastatic cancers and higher stages will screen the letters a second time to ensure they’re appropriate.

Kathleen Ellis of Austin, Texas, underwent breast cancer surgery on May 6. In June, her oncologist handed her one of the Girls Love Mail envelopes. “I opened it and it said, ‘To the awesome woman holding this card’. I just burst into tears. It was a such a sweet thing from a stranger.”

Ellis, 71, had memories of her mother, who died in 1996, writing letters at a card table nightly. “It’s become rare. We don’t often get personal mail from people anymore. And it takes more time than hitting ‘send’ on an email.” The labour felt personal to Ellis. “Even if the woman who sent this wrote a bunch of letters with exactly the same language, I got it.”

Many studies show a connection between social support and health outcomes. “If people have emotionally supportive relationships or are embedded in a network of people who are supportive, that has been linked to better mental health and longevity,” said Bert N Uchino, who is chair of the psychology Department at the University of Utah and has conducted research on the subject.

“Definitely what I see is that these letters give these patients a network of support,” said Stephanie Brown, a breast cancer nurse navigator at Sutter Health in Sacramento. “And something that is tangible to them that they will keep and cherish throughout their entire cancer journey.” She knows the letters are effective because patients often come back and write letters for others.

Brown believes the best letters are “ones that say, ‘I know you’re going through a hard situation, but stay strong and positive and know that people are thinking about you, and they care about how you’re doing’. “

Uchino points out some seemingly supportive messages aren’t appropriate. “Saying, ‘I know you’ll be fine’ can be unhelpful and minimises the problem,” he said. “We need to make sure the support is responsive to that person’s needs; otherwise, it’s even more of a stressor.”

Mulligan is sensitive to ensuring the letters are helpful. With her team of 15 volunteers, she said, “We read every letter, and we post guidelines on our website. We have figured out that some wording doesn’t work, so we don’t mention death, and we leave out religion. We make sure the letters sound encouraging, which I know is subjective, without belittling the experience.”

The first requirement is that the letters be handwritten. “Part of what makes the letters special is that handwriting is unique. Even people crossing things out and making mistakes, that gives it personality. We’ve had people use handmade papier-mâché paper, make drawings and add stickers or crocheted elements. One woman even made a needlepoint card.”

Mulligan’s other tips for writing letters include:

– Start with your favourite quote and use that as a launchpad.

– Think of a loved one while you’re writing.

– Write from the heart; you can’t go wrong.

She notes that while many of the letters are written by breast cancer survivors, most are not. Surprisingly, “one of the biggest demographics we get are high school and college-age writers.

“They think it’s very retro to pick up a pen.” An all-girl high school in Covington, Louisiana, wrote 792 letters in one day.

“A women’s prison in Ohio sends a giant box of letters every month. Letters arrive from all over the world – in Tagalog, French, German and Chinese (foreign-language letters are forwarded unscreened). She said the organisation needs more letters in Spanish, “We get very few. And it’s wonderful to get a letter in your native language.”

Some letters deserve a wider audience, Mulligan believes. In 2017, she published 100 such letters she had set aside over the years, including one from a woman involved in the first tamoxifen study in 1970s.

The collection is called Dear Friend: Letters of Encouragement, Humor, and Love for Women with Breast Cancer.