Hair loss and metastatic breast cancer
If your metastatic diagnosis is your first bout with breast cancer, you may wonder what effect treatment may have on your hair. You may feel it’s silly or vain to worry about losing your hair when you are facing such a medical challenge. On the other hand, if this diagnosis is a recurrence, you may feel like you’re about to experience an invasion of your privacy—that your head will soon signal to the world that your cancer is back. Or, if you lost your hair before, you may just dread losing it again.
It’s OK to feel distressed at the thought your hair may thin or fall out completely. Your hair is part of who you are, and losing it can make you feel a loss of control. Women from many cultures and backgrounds find that hair loss affects the way they view their bodies and femininity.
On the other hand, you may not feel strongly about the potential loss of your hair. You may see hair loss as one more sign that you are doing what you can to treat the breast cancer. There is no right or wrong way to feel.
It can help to understand why hair loss may occur during breast cancer treatment and have some ideas on how to manage it.
Hair loss does not cause pain, but before your hair falls out, you could feel scalp tenderness or discomfort.
Hair loss usually doesn’t start until after a few treatments. You may lose hair in the shower or notice clumps on your pillow, comb or brush. Your eyebrows, eyelashes, pubic hair and the hair on your arms, underarms and legs also may fall out.
If you had early-stage breast cancer before your metastatic diagnosis, your experience with hair loss could be different this time. The type, nature and extent of hair loss depend on the medicines you take and the regimen you receive.
Over time, you are likely to receive different treatments for metastatic breast cancer. This means you could lose your hair more than once as you move from treatment to treatment. Before you start a treatment, ask your doctor what to expect. Your providers should be open to discussing hair loss with you.
Many cancer treatments are designed to kill quickly dividing cells. Cancer cells divide rapidly, but so do some healthy cells, such as those found in hair. Hair follicles are among the most quickly growing cells in the body and are likely to be harmed by cancer treatments.
Not everyone loses hair during breast cancer treatment. If you have chemotherapy, you may be more likely to have hair loss because chemotherapy medicines go after quickly dividing cells. Some chemotherapy medicines make all your hair fall out. Others thin or change your hair, and still others might not impact your hair at all. Whether and when hair loss happens depends on the type of chemotherapy medicines you receive. The dose and timing of treatments may also be a factor.
Other cancer treatments can also affect your hair:
If you had a recurrence, your reaction to hair loss may be very different than it was the first time around. It may bother you less because you feel you’d rather focus on other concerns. Or you may feel more emotional about the hair loss because of its tie to your metastatic diagnosis and treatment.
Some women want to take charge by shaving their heads, or cutting their hair very short, before the hair falls out. You may find it empowering to do so. Or you may prefer to wait and see.
If you wish to cover your head, you may want to explore your options ahead of time. You could choose a wig that resembles your natural hair or one that gives you a new look, or you could buy caps and brightly colored scarves.
Heat escapes from the tops of our heads. Without hair, you may find yourself feeling chilly. Buy hats to protect your scalp from the sun and to keep warm. If you don’t want to cover your head, it is perfectly fine to go bald.
It would be great if there were a simple pill to prevent hair loss or a magic lotion you could rub on your scalp to keep your hair full. There isn’t such a product (though you might see some that make the claim), though research into how to minimize cancer effects, including hair loss, is ongoing.
You may have heard of a product referred to as a “Chemo Cold Cap,” which is like an ice pack for the scalp. It is believed to work by cooling the temperature of the scalp so that chemotherapy doesn’t get inside the hair follicles. Some hospitals are trying the caps, and early reports are promising. This approach is still being studied, and providers do not yet know the long-term impacts of the treatment. Talk with your doctors before trying this technique.
The American Cancer Society offers these tips on ways to be gentle to your hair during cancer treatment:
- Use mild shampoo
- Use soft-bristle hair brushes
- Use low heat if you use a hair dryer
- Don’t use brush rollers
- Don’t dye or perm your hair
- Use a satin pillowcase
Your feelings on hair loss may change as your therapy for metastatic breast cancer changes. You may decide that you don’t want to continue with certain medicines. For some people, it can be freeing to see their hair grow back, even if the cancer hasn’t gone way.
If your hair is very important to you, talk with your doctors about options less likely to cause hair loss. You may be able to start or change to a different medicine that works as well against the breast cancer. Talk with your providers about how they will monitor the impact of any changes to your treatment.
Although one goal of your treatment is to keep the cancer under control for as long as possible, a second, equally important goal is to allow you to live a good life. Remember, your needs are an important part of your treatment plan. Open communication with your providers is very important. You and your providers will decide together whether a certain treatment is right for you.