For individuals diagnosed with breast cancer, hair loss, also known as alopecia, can be a particularly distressing side effect of treatment. Major surgeries, cytotoxic chemotherapy, and endocrine therapy may all result in different types of alopecia. However, understanding the causes, potential prevention strategies, and available treatment options can empower patients to manage this challenging aspect of their cancer journey.
Several types of hair loss can occur in breast cancer patients as a result of treatment:
Chemotherapy-Induced Alopecia (CIA): This is perhaps the most well-known type of hair loss associated with cancer treatment. Certain chemotherapy medicines used to treat breast cancer can cause the hair on your head to become thin or to fall out completely. Chemo and other cancer treatments can cause hair loss by targeting rapidly growing cells-including hair follicles-which spurs hair loss. It can happen on the head and other areas of the body, depending on the treatment. Another side effect of chemo is hair loss on other parts of your body, such as your eyebrows and eyelashes, pubic hair, and hair on your legs, arms, or underarms. The reason chemotherapy can cause hair loss is that it targets all rapidly dividing cells - healthy cells as well as cancer cells. Hair follicles, the structures in the skin from which hair grows, include some of the fastest-growing cells in the body. If you're not in cancer treatment, cells in your hair follicles divide every 23 to 72 hours. But as chemotherapy does its work against cancer cells, it also damages hair follicle cells. Within a few weeks of starting certain chemotherapy medicines, you may lose some or all of your hair. The hair loss can happen gradually or fairly quickly.
Telogen Effluvium: This is a temporary form of hair loss that can occur after a stressful event, such as surgery or a cancer diagnosis.
Endocrine-Induced Alopecia: Some hormonal therapies used to treat breast cancer can cause mild to moderate hair loss, or hair thinning, often at the frontal hairline, the middle part, or the crown of the head. Hormonal therapies work either by lowering estrogen levels or by blocking the effects of estrogen in breast tissue. Researchers don’t know exactly why hormonal therapies cause hair loss. But experts say one of the reasons is that lowering estrogen levels reduces the growth of hair follicles.
Read also: The Hair Dye-Cancer Link
The first step in managing hair thinning or hair loss is to understand how likely it is with your treatment plan. It's important to have an open conversation with your healthcare team to gather information specific to your situation. Here are some questions you can ask your care team:
Whether you lose your hair and how much you lose depends on a variety of factors. This includes the type, combination, and dose of chemotherapy medicines you get, as well as other medical conditions (such as thyroid disease), nutrition status, and stress. The timing of chemotherapy treatments also affects hair loss. Some types of chemotherapy are given weekly and in small doses, which may minimize hair loss. Other types of chemotherapy are scheduled every three to four weeks in higher doses and may be more likely to cause more hair loss. Talk with your doctors before chemotherapy begins so you know what to expect in your individual situation.
While not all breast cancer treatments will cause you to lose your hair, some treatments, especially chemotherapy, will cause hair loss. Hair loss typically begins gradually within a couple of weeks of starting chemotherapy. You might find clumps of hair in the shower, on a pillowcase, or hairbrush.
If your treatment causes hair thinning or loss, it’s important to do what feels best to you, helps you feel confident, and makes you comfortable. Here are several strategies for managing hair loss during breast cancer treatment:
Cutting Your Hair: With the total hair loss that can happen as a result of some chemotherapies, many people find it empowering to shave their heads, or cut their hair very short, before it falls out. Others may wait until a lot of hair has fallen out before cutting or shaving it. Gradually cutting hair shorter over the course of a few days or weeks helps some people ease into the idea of having no hair. Some breast cancer patients choose to cut their hair in stages, while others prefer a single event. Get a short haircut. The process of your hair falling out is stressful, and with long hair, it’s even more obvious, which usually makes the process even more distressing. By cutting your hair shorter you will have less hair to fall out and shorter strands when it does.
Read also: The Connection Between Hair Loss and Cancer
Gentle Hair Care: Here are some ways to be gentle to your hair during cancer treatment:
Exploring Head Covering Options: If you choose to cover your head when hair falls out, you may want to explore your options ahead of time. You can choose a wig that resembles your natural hair or one that gives you a new look. Other options include hats, caps, or scarves. Many women alternate between all of these. Purchase a wig before your hair falls out. If you’re going to wear a wig it helps the stylist know what you normally look like, and they can style a wig to match that. Have hats and/or head scarves handy. Especially during Colorado winters, your head will need to stay covered so you can stay warm! Scarves make it easier to cover your ears, although soft stocking caps can feel good too. Choose something that matches your personality and style. If you decide that you’re not going to wear any type of head covering, especially on warm days, be sure to protect your scalp by wearing sunscreen.
Maintaining Warmth and Comfort: Heat escapes from the tops of our heads. Without hair, you may feel chilly at times. If you don’t want to cover your head, it is perfectly fine to go bald - just remember to use sunscreen, and have a hat on hand to make sure you’re warm enough.
Sun Protection: If your head is going to be exposed to the sun or to cold air, protect it with sunscreen or a head covering.
Understanding Scalp Cooling: You may have heard of scalp cooling, a therapy that helps some people keep some or all of their hair during chemotherapy. Scalp cooling involves wearing a cooled headpiece during chemotherapy sessions. Since you’re lowering the temperature of your hair follicles and scalp, the blood flow to the area is slowed. As a result, hair follicles are less exposed to the chemotherapy medicines. Scalp cooling or cold caps can help to prevent cancer treatment-related hair loss. This involves wearing a tight-fitting hat on your head that has a cold gel or liquid coolant. By keeping the scalp cold during your chemotherapy infusions, blood flow to the scalp area is restricted. This helps reduce how much chemotherapy reaches those cells.
Read also: Coping with Hair Loss During Cancer
Methods of Scalp Cooling: There are two available scalp cooling methods:
Effectiveness of Scalp Cooling: Research shows that scalp cooling helps some people keep their hair throughout chemotherapy. When using a scalp cooling system, you’ll wear a scalp cooling cap each time you have a chemotherapy infusion. Typically, you will wear it for about two and a half hours total. You may experience mild side effects such as headaches, scalp pain, or feeling chilled. Some studies have shown that cooling caps might not work well on hair with tight curls and coils. This type of hair is more common in Black people. Tight curls and coils might prevent the cap from getting the scalp cold enough. People who have curly or textured hair may want to take extra steps to improve the likelihood that scalp cooling will be effective for them.
Minoxidil (Rogaine): Some research has shown that minoxidil (often sold as Rogaine) can help hair grow back faster after chemotherapy. If you’re interested in trying minoxidil, ask your doctor to confirm that it will be safe for you. For mild to moderate hair loss, dermatologists often recommend Rogaine (chemical name: minoxidil), an over-the-counter medication that promotes hair growth. It’s safe for people with a history of breast cancer and moderately effective. But check with your oncologist before you start using minoxidil. In most cases, you can use it while you take hormonal therapy or targeted therapy, but not during chemotherapy treatment. Look for products labeled “5% minoxidil foam” (generic versions are fine) that you apply to your scalp when your hair and scalp are dry. It’s ok for women to use minoxidil products labeled for men. Minoxidil is thought to stimulate hair growth by improving blood flow in the scalp and prolonging the growth phase of each hair follicle. Oral minoxidil is a commonly prescribed treatment for hair loss. The drug is also the active ingredient in the over-the-counter medication Rogaine.
Hormone Replacement Therapy (HRT): While you may hear about some women using hormone replacement therapy (HRT) to help with hair thinning related to reduced hormone levels, HRT has been shown to increase the risk of breast cancer and is not recommended for people who’ve been diagnosed.
Nutritional Supplements: Some dermatologists may recommend certain nutritional supplements to help speed up hair growth, such as Nutrafol and Viviscal Hair Growth supplements. Always check with your oncologist before you start taking a nutritional supplement. Biotin supplements should be avoided because they can cause you to have incorrect results from lab tests, such as cardiovascular diagnostic tests and hormone tests.
Good general nourishment and the avoidance of extra chemicals - such as minoxodil - may help the healing process. Both chemotherapy itself and the hair loss it causes can make your scalp feel rough and itchy, too. So, anything you can do to use fewer chemicals there would probably be prudent.
Some of the other products you might want to try for mild to moderate hair loss include:
Some people have scalp pain, tingling, burning, or tenderness during and after losing their hair. The medical term for this is trichodynia. It more commonly occurs when the hair loss is from chemo, but can in rarer cases occur with hair loss from other breast cancer treatments such as hormonal therapy. There are a few medications that may be helpful for easing the discomfort, such as topical steroids and anti-inflammatory pain medications. If you’re experiencing scalp pain from hair loss, ask your medical team about treatments you can try that won’t interact with any other medications you are taking.
For most people, their hair grows back after the chemo treatments are complete. The amount of time it will take for hair to grow back varies a lot from person to person. You may start to see some soft fuzz growing back in between chemo cycles (when you have a few weeks off of chemotherapy). Most people start to see some hair growth in the first 3 to 4 weeks following treatment. Then, by about one month to 6 weeks after treatment, you could start to see some real hair growing.
Here's a typical timetable for hair regrowth on the head:
When your hair starts to grow back, it will probably be slightly different from the hair you lost. Your new hair might have a different texture or color. It might be curlier than it was before. You may notice that your hair is a different texture or even color as it returns. The hair on your head may be a different color, texture, or volume when it grows back. If you were dyeing or chemically treating your hair before you started chemotherapy, you might be surprised to see what your natural hair looks like when it grows back. In many cases, hair eventually returns to the way it used to be after the effect of chemotherapy on the hair follicle wears off. But some people have incomplete hair regrowth. Sometimes permanent baldness and loss of eyebrows and eyelashes can occur, particularly in people who received Taxotere. It's likely that your hair will come back slowly and that it might not look the same right away. But growth takes time.
Continue gentle hair care. Your new hair growth will be especially fragile. It may be more easily damaged by styling products and heating devices. Hold off on coloring, relaxing or bleaching your new hair until it grows stronger. Stay away from any products that chemically curl or straighten hair. We’d also never recommend dyeing or coloring it.
Breast cancer treatments such as hormonal therapy, targeted therapy, and chemotherapy can cause some people to have ongoing mild to moderate hair loss. If you’re concerned that your hair isn’t growing back or is noticeably thinner than in the past, it’s a good idea to see a dermatologist. If possible, seek out one who specializes in hair loss or an onco-dermatologist who focuses on problems with the hair, skin, and nails that can develop during cancer treatment. The dermatologist will order blood tests to check whether there are other reasons for your hair loss besides the effects of breast cancer treatments. Thyroid problems, nutritional deficiencies, and other factors can play a role in hair loss.
Hair loss (also called alopecia) may be one of the most dreaded side effects of some treatments for breast cancer. Whether you experience hair thinning or the complete loss of your hair, any hair loss can be traumatic. Like many people, you might feel that the hair on your head is a big part of your identity. Losing it can make you feel self-conscious and exposed. You might assume that your hair loss signals to everyone that you have cancer. Hair loss can be traumatic in part because it’s so visible. You may feel that it reveals to the world that you’re a cancer patient, threatening your privacy. And you may have to deal with it around the same time that you’re facing other unwanted changes to your body and appearance due to treatment. Of course, not everyone reacts to treatment-related hair loss in the same way. For some, it can be devastating, especially at the beginning. For others, it’s a big inconvenience but it doesn’t affect them as deeply.
One thing that may help make hair loss easier is knowing what to expect. Ask your doctors if the treatments you’ll be receiving are likely to cause hair loss, to what degree, and when it may occur.
If you’re worried or upset about hair loss, try not to isolate yourself because you’re embarrassed or fear being judged as superficial. Talk about your feelings with understanding friends and family members, a mental health professional, or a social worker at your local cancer center. Also, try seeking out an in-person support group or an online community for people with breast cancer. Connecting with others who are going through cancer treatment and experiencing hair loss can be particularly helpful since they understand what you're going through.
If you have young children, you may be concerned about how they’ll react to seeing you lose your hair as a side effect of chemotherapy. Experts say that no matter the age of your kids, it’s best to prepare them before your hair falls out with honest, age-appropriate information about what to expect. Since kids often follow your lead, reassure them that though you may look different without your hair, you’ll still be the same you. It can be helpful to remind them that your hair will grow back. It might also make them feel better to participate in some of the things you’re doing to prepare, such as picking out hats, scarves, or other head coverings, or shaving off your hair.
There tends to be a lot less stigma with being open about a cancer diagnosis in the workplace than there was even a generation ago. If you’re planning to continue working or to job hunt during treatment, you’re likely to find that many colleagues are understanding about what you’re going through. Still, it’s up to you to decide how comfortable you feel telling your colleagues or others you interact with in your job about your diagnosis and treatment. If you’ve lost your hair and you want to maintain your privacy at work, you might choose to wear a wig that looks as close as possible to your natural hair and to otherwise conceal your hair loss (such as by penciling in your eyebrows). If you’re not as concerned about privacy, you might wear a scarf or choose not to hide your hair loss. How you decide to handle hair loss at work might also depend on your job role and industry. For instance, if you work in a field in which your appearance is front and center more, you might decide that concealing your hair loss on the days you go to work helps you feel more confident.
Several organizations offer support and resources for individuals experiencing hair loss due to cancer treatment:
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