Breast Cancer Death of

Empress Theodora,

Wife of Justinian I of Byzantine,

In The Sixth Century

Arne N. Gjorgov

Healthgrouper republishes this fascinating historical article on the life and death of Theodora, Empress of the Roman Empire and the wife of Emperor Justinian I, in memory of Dr Arne N. Gjorgov, an epidemiologist and philosopher from Macedonia, who died in Skopje at the age of 83


Empress Theodora (503-548 AD) comes from deprived parents – daughter of a bear-keeper in the dens of the Hippodrome in Constantinople. As a stage dancer, hetera and courtesan, she became a follower, wife and adviser to Emperor Justinian I (482-565 AD). She died of breast cancer at her 45 years of age (after 27 years of marital fidelity to Justinian). The destiny and the life story of Theodora have always hoisted curiosity and interest in both historical and popular literature. In the study, an attempt was made to shed additional light upon certain aspects of her marital life. The objective of the investigation was to explore and to reassess the intimate environment, life’s events, and the postulated etiological cause in connection with her rare disease, cancer of the breast, and its relevance to the present day breast cancer epidemic. The investigation focuses its attention to the risk factors and the conditions conducive to the development of breast cancer in married women, in order to corroborate the potential of primary prevention of the disease in the community.


Theodora I, was empress of the Roman Empire and the wife of Emperor Justinian I. Theodora is perhaps the most influential and powerful woman in the Roman Empire's history.The destiny and the amazing history of Theodora (503-548 AD), Byzantine Empress, as the wife of Emperor Justinian I (482-565 AD), has always produced curiosity and interest in the historic and popular literature as a famous woman and a successful empress. Stretching from the meager beginnings of the dens and stages of the Hippodrome, in Constantinople, and reaching the majesting heights and imperial throne of Byzantium, her life story entered the realm of legends. Even during her life, she had been an object of intrigue, jealousy and gossip, which episodes were collected by Procopius of Cesarea, a historian of the emperor’s palace, a contemporary and eyewitness, in a written account, “Secret History” or “Anecdota” (1).

In this and other works of Procopius there are many detailed passages, some of them offensive and harsh, about the personal mentality of Justinian and Theodora, related to state, religion, family and health matters. In a passing reference, it was mentioned that “Theodora died of breast cancer, on June 29, 548, at age of 45,” after a long and tortuous disease. In the available literature, her death seems not fully elaborated either by Procopius or by the other historians or writers (2). The cause of her breast-cancer death is reviewed here within the framework of the latest, tested postulates and knowledge in the etiology of breast cancer (3, 4).

Breast cancer, although known from the biblical times, has been a relatively rare disease throughout history. Until recently, in most regions of the Middle East and Far East, where breast cancer was only known to appear in the harems of Oriental rulers, the females of the general populations were virtually free of this malignant disease (5).

The aim of this study was to appraise the evidence and assumptions in the literature of the events in the life of Empress Theodora, both before and after marriage, in order to try to assess and explain the consistency of the conditions conducive to and the putative cause of her breast cancer in accord with the postulated and tested cause of the epidemic rise and proportions of the disease in (married) women of the contemporary world (3, 4).

Sources, Background and Methodology

A great deal of the narrative of the Secret History of Procopius (1) is devoted to the youth and life of the future Empress Theodora, in retrospect. All works of Procopius (The Wars, in eight divisions, about the Persian, Vandal and Gothic Wars, Secret History, and Buildings) are the main and often the only historical source (2) for the reign of Justinian I (527-565 AD), at the down and the foundations of the Byzantine Empire. The work Secret History was written with virulent attacks on the “demonic nature” of Justinian and Theodora and containing explicit sexual description, which has been judged by many historians as biased and untrustworthy evidence. Apparently, the author was hiding his work, which remained unfinished when he died (in 550 AD), and a few people in the Empire seems had ever known about it. The manuscript of the Secret History has survived, however, and was discovered in the Vatican Library in 1623, almost 1,100 years after it was written, and the death of Procopius.

In a relevant event, a case-control study was conducted at the University of North Carolina, at Chapel Hill, NC, and at the University of Pennsylvania, in Philadelphia, PA, USA, between 1974 and 1978, in order to test the hypothesis that a reduced exposure to human seminal factors in the reproductive lives of women is a risk factor of breast cancer in married American women (3, 4). In terms of human reproduction, the semen-factor hypothesis was defined in terms of married women who have been exposed to barrier contraceptive methods (specifically, the use of condoms or withdrawal practice) and women who have been living in infertile marriages due to male infertility. The results of the study corroborated the tested hypothesis and provided evidence of a strong relationship between the long-term use of condoms and the risk of breast cancer in married women. The extended reduction/elimination or absence of the seminal factors (prostaglandins?), rather than reduced fertility (childbearing) of the contemporary marriages, was found to be the possible risk factor accounting for the rise of the incidence and the epidemic spread of breast cancer in the U.S. and most of the advanced countries of the West. The practical application of the confirmed semen-factor hypothesis was the potential for prevention of breast cancer as an epidemic disease in the community. The unforeseen developments of promoted indiscriminate condom use (as technically induced effects of total male sterility on an unprecedented scale in the community) in the 1980s and until recently, further confirmed the condom-breast cancer association and the postulated potential for primary prevention of the disease (6-9). During the course of a prior post-graduate study in International Health Development, at the Royal Tropical Institute, in Amsterdam, The Netherlands, in 1968, in the sessions of Epidemiology, it was discussed that breast cancer was frequent in Catholic nuns (10), with a passing remark, however, that cancer of the uterine cervix was frequent in prostitutes of Amsterdam. Although the topic was not further elaborated, an idea was personally deducted: the semen! The idea being of lack of exposure to human semen in the former, and of excessive, unclean exposure to semen in the latter category of women. The gestating idea of the role of male, seminal factors in women’s illnesses was not forgotten, until the chance to test it as an explicit hypothesis of a possible cause of breast cancer, a disease of high priority in the U.S., during the 1970s, and long ever since.

Besides the assessment of the breast cancer death of Empress Theodora, the aim of the study was extended to a limited appraisal of Emperor Justinian I, for both reasons, as the husband of Theodora, for 27 years, and as a compatriot, and founder of Justinian Prima, near Skopje, as the place of his birth and youth, the region renamed and known as such in the Sixth Century.

Justinian I became emperor of Byzantine in 527 and ruled until his death in 656. He was born in 482, near Skopje, Macedonia, between the villages of Bader and Taor (11). The villages still exist and are inhabited under the same names (with an area, called “Gradishte,” or palace ruins, in between). As a relative of the childless Emperor Justin, Justinian was taken to the imperial palace in Constantinople, changed his (Slavic?) name from Upravdin (12,13) to romanized Justinian, and was educated and groomed to inherit the throne of the Byzantium. As a great emperor, Justinian I was one of the most important of the Byzantine emperors (14). He launched three ambitious projects (15). First, he tried, but failed, to reunite the Eastern and Western Roman Empires. However, trade helped spread the great culture of the advanced civilization of Byzantium to Italy and to Western Europe. Second, Emperor Justinian I ordered his lawyers and other scholars to organize, simplify and systematize the laws of ancient Rome into the voluminous Corpus Iuris Civilis (Body of Civil Law), written in Roman and later in Greek language. The Corpus remained the basic law for most of the European states until 18th Century. Third, he undertook a massive building program in Constantinople and across the empire. In the capital, he built the magnificent church Haggia Sophia. In his birth place, today’s Skopje, he built a new city, Justiniana Prima, as an administrative and religious center of the same province, with extensive infrastructures and buildings (16-19).

Considerations about the premature breast-cancer death of Theodora and the circumstantial evidence of her marital life with Justinian cannot go beyond Procopius’ and other historical facts. Only the efforts in interpreting the evidence may differ from the conventional views on the matter, in accordance with the tested semen-factor (deficiency) hypothesis in breast cancer.

Evidence and Observations According to Procopius, Theodora was born in 503 AD, in the dens of the amphitheater of Constantinople, where her father was beast-keeper, and was called the Bearkeeper. The father died soon, leaving three daughters and wife, who soon remarried. Along with her two sisters, Comito, the older, and Anastasia, the younger, Theodora was exposed to begging at a very early age, at eight years, and was introduced to the stages of the theater, as hetera, in her adolescent years. She was exposed to all kinds of “unnatural violence of the corrupt slaves following the masters in the theater.” Her mother has set the stage for her public exposure and Theodora “instantly became a courtesan, or as the old Greeks called, an ordinary whore… She did not play flute, nor she danced; she was only showing her youth to everybody, entirely consenting… She was not embarrassed and could not be surprised by anything, and no role was scandalous enough to make her blush.” She attracted everybody, especially the younger males, and became very mean, like a scorpion. A number of abortions and the birth of a daughter during that time were alleged by Procopius. At an early age she got married to an official, and followed him to Alexandria, in Egypt, where she divorced him soon. But when she returned to Constantinople, by practicing prostitution all along the way back, Justinian wildly fell in love with her. Theodora was beautiful and had a captivating personality as a dancer and entertainer. At first, Theodora was mistress until he elevated her to the position of a noblewoman. According to the old laws, Justinian as a senator and heir apparent could not marry a prostitute. However, after the death of his uncle, the Emperor Justin, and his aunt the Empress, who objected strongly to Justinian’s wedding plans, he cancelled the old laws and regulations and inaugurated a new one which allowed him to marry Theodora, and everybody else to marry a prostitute as well. The wedding ceremony in full imperial splendor took place in the Haggia Sophia cathedral, three days before Christmas, in 542 AD. Procopius called Emperor Justinian and Empress Theodora not a husband and wife, but “brother and sister” and “friends in human form.” Some historian consider this statements as a further “extreme view by a biased historian” (14), although in all possibility, Procopius discreetly indicated an absence of intimate, physical love of the married couple. There is no reason, whatsoever, to doubt the text. Other cited sources of the Justinian’s time (2) refer to Empress Theodora as woman “from the brothel” and “formerly shameless but later chaste.” Justinian was 21 years senior of Theodora, and married her at the age of 45. During the courtship, Justinian fell gravely ill and thought he may die, according to the Procopius account. As an empress, Theodora showed to be, or has developed an iron will, letting nothing to stand in the way of her ambition. She was cruel, and she wanted and held power, sharing absolute power loyally with Justinian. He always consulted her on major matters of state or church before reaching a joint decision (9). Procopius makes some unpleasant parallel of Theodora to other woman in her entourage, Antonina, leveling accusations of their sexual lives: both women are said to have given births in their depraved days, abortions, infanticide, and lack of maternal feelings. Theodora had an illegitimate daughter and a son of her first marriage. He further reports that as empress, Theodora often intervened to help individual girls and women in distress, founded a famous Monastery of Repentance for reformed prostitutes, and was a fierce supporter of marital fidelity.

However, Procopius who was hostile to Theodora from the beginning never accused her of sexual infidelities after the marriage to Justinian, neither of promiscuity nor of adultery. Accordingly, Theodora may have fulfilled 27 years of marital fidelity to Justinian. In a bizarre episode, Theodora ordered a cruel and brutal flagellation, in front of her eyes, of a favorite, young and good-looking slave, to whom, reportedly, she was emotionally attached and pleasant previously. No temptations.

Justinian was described by Procopius as weak, subjective, jealous, and dominated by a powerful wife. Procopius emphasizes the long fasting practices of Justinian, especially his self-depravations and extreme asceticism, as signs of holiness. The couple was described as “demons in human forms,” but Procopius never accused Justinian as he did Theodora of sexual excesses in his life. Justinian was troubled by a notable lack of sleep, with nocturnal wanderings around the Place, and habitual underweight. The evidence given by Procopius and other historical sources indicate a possibility of a long-time sexual abstinence in the crowned imperial couple, and a brave endurance and true sacrifice of Theodora in this regard, most probably for the sake of her imperial prestige and dignity. Obviously, sacrifice of sexual life to an accomplished woman like Theodora must have been agonizing and consciously painful.

Theodora died in 548, at age of 45, after a long battle and suffering from breast cancer. She may have developed and discovered the breast malignant growth early in her 40s, during her relatively young reproductive age. Her sad likeness can be seen in the sixth-century mosaic, beside the one of her husband, in the church of San Vitale in Ravena, Italy.

The mosaic has been described vividly: “Over the pale slight figure of Theodora hangs the glamour of early death and a sorrowing imperial husband” (2). This mosaic, in a church distant from Byzantine, testifies to Theodora’s enormous influence on the Eastern Roman Empire and beyond.

Discussion and Conclusion

Theodora should be evaluated and judged more favorably in history. At least, with her courage she was instrumental in saving the existence of the empire and probably the life of the emperor during the bloody “Nika” riot at the Hippodrome, in Constantinople, in 532, at the expense of more than 30,000 citizen’s deaths. Theodora was absolutely determined to remain empress, to struggle like an empress, and to die as an empress (20). Nothing else mattered to her but the imperial power. Justinian could hardly be able to humanly carry out his monumental and ambitious projects had his bellowed wife, Theodora, not always been committed and sensible to him, with loyalty, political support, religious consensus and, presumably, consenting to long sexual abstinence. She might have been aware of the pains of her protracted intimate sacrifice. The Scriptures give ground for debates of sexual relations, human seed, marriage, love, conception, the “sin against nature” of sterile acts (coitus interruptus), prostitution, adultery, and the polemic that “husbands are the chief persons responsible for dissipation of their wives” (21).

The early serious ailments in the life of Justinian, as well as his affliction and unexpected survival within the (first) plague epidemic in Constantinople, 514-542 (22), were recorded in the Procopius works. Perhaps the truth could not be violated if it is assumed that the evidence about the lack of fitness, ill health, and excessive asceticism of Justinian provide information for assessing the cause for and fault of their infertile marriage. Theodora’s death of breast cancer, not of cervical cancer (as observed in courtesans), seems a kind of testimony to and is consistent with the tested semen-factor hypothesis in the etiology and epidemiology of breast cancer. In accord with the aims of the study, it seems that the historic breast cancer, developed early in Theodora’s life, may further help explain and corroborate the conditions conducive to breast cancer, by the postulated long-term marital exposure to sterile mating, because of barriers to insemination, or condom use, and the potential for prevention of breast cancer as an epidemic disease in women of the contemporary world.


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