Breast cancer and hair loss

1. Will I lose my hair during breast cancer treatment?
2. Why does chemotherapy cause your hair to fall out?
3. Can cold caps and scalp cooling prevent hair loss?
4. Do other breast cancer treatments cause hair loss or thinning?
5. Looking after your hair during breast cancer treatment
6. Will I lose my eyelashes, eyebrows and body hair during chemotherapy?
7. Can breast cancer treatment cause permanent hair loss?
8. What to expect if you lose your hair

1. Will I lose my hair during breast cancer treatment?

Many people will lose either some or all of their hair as a result of treatment for breast cancer. People who have chemotherapy will often experience hair loss. Some other treatments may cause hair loss or thinning.

If there’s a chance that you will lose your hair, your specialist, chemotherapy nurse or breast care nurse will talk to you before treatment starts about what might happen. This should also include information about any risk of permanent hair thinning or loss that could happen as a result of the treatment. As well as talking about practical issues such as caring for your scalp or wearing a wig, you can also discuss your feelings about losing your hair and what support might be available to help you adjust to it.  

For some, losing their hair is the most distressing side effect of treatment. Find out more about coping with hair loss.

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2. Why does chemotherapy cause your hair to fall out?

Chemotherapy drugs target rapidly dividing cells, so they damage some healthy cells as well as cancer cells. The healthy cells damaged include the cells in the hair follicles, which is why chemotherapy can make your hair fall out. As well as the hair on your head, this can also affect your body hair including eyebrows, eyelashes and pubic hair, and chest hair for men

Not all chemotherapy will make your hair fall out. Some drugs don’t cause any hair loss, some cause hair to thin, while others make hair fall out completely. How much hair you lose will depend on the type of drugs you are given and the dose. Drugs that are given in smaller doses on a weekly basis or are taken by mouth are less likely to cause hair loss. If you are receiving a combination of chemotherapy drugs you are more likely to have hair loss. Your specialist or your chemotherapy nurse will talk to you about your treatment and how likely you are to lose your hair.

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3. Can cold caps and scalp cooling prevent hair loss during treatment?   

Cooling the scalp can sometimes prevent or reduce hair loss from the head for both men and women having chemotherapy. This technique works by reducing the blood flow to the hair follicles, which means that the amount of drugs reaching the hair follicles is also reduced.

The effectiveness of scalp cooling varies depending on the drug and dose used, and from person to person. If you do keep your hair, you may find that it’s patchy or thinner. Scalp cooling is often less effective on African and Caribbean hair, so increased cooling times may be recommended.

There are two widely available ways of cooling the scalp. One method uses a cold cap, which is a hat filled with a gel that can be chilled. The other system uses a small, refrigerated cooling machine to pump a liquid coolant through the cap. In both cases the cap is worn before, during and after chemotherapy, so scalp cooling can mean you’re at the hospital for longer.

You can ask your specialist or chemotherapy nurse if scalp cooling is available and whether it would be suitable for you. The condition of your hair and any previous use of chemicals on it may affect how well scalp cooling works. Your chemotherapy nurse will discuss this with you.

Some doctors have been concerned that scalp cooling may increase the risk of developing secondary cancers in the brain or scalp due to the possibility of constricted blood vessels limiting the amount of chemotherapy reaching the area.

However, studies looking at many people who had scalp cooling during their chemotherapy treatment have found that scalp cooling does not increase this risk.

To improve the chances of the cold cap being effective, it’s important the cap covers the whole scalp and fits snugly. You may find the cap uncomfortable, as it’s very cold and often quite heavy. Some people get headaches, but these usually wear off quickly once the cap is removed.

Read our blog Cold caps: do they work?

Tips for scalp cooling

To improve the chances of the cold cap being effective, it’s important the cap covers the whole scalp and fits snugly. You may find the cap uncomfortable, as it’s very cold and often quite heavy. Some people get headaches, but these usually wear off quickly once the cap is removed. You don’t need to cut your hair short before you start treatment, however if your hair is very long or thick it may be helpful to cut it to reduce some weight and make it more manageable.

So that the cold can reach the scalp the chemotherapy nurses may recommend that the hair underneath the cap is lightly dampened. Before the cap is fitted the hair can be sprayed with lukewarm water. A water spray bottle is ideal for this.

Applying a small amount of conditioner to the dampened hair can help with removing the cold cap at the end of treatment. There is no need to leave the conditioner in your hair unless you feel unable to wash it out.

Before the cap is put on the hair should be gently combed back using a wide tooth comb or your fingers so that the front hairline is visible. This is especially important if you have a fringe.

Being able to tolerate the cold will vary widely from person to person. The intense feeling of discomfort or even aching that is felt in the first 10-15 minutes of the treatment should go away as you get used to the cold. Wearing warm layers, sipping hot drinks and covering yourself with blankets can also help.

As the hair will still be damp when the cold cap is removed you may find it more comfortable to take a hat or head covering with you to wear on the way home.

Things like water spray bottles, conditioner and extra layers may not be available in the chemotherapy suite so you may want to bring your own.

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4. Do other breast cancer treatments cause hair loss or thinning?

Targeted therapy

Most targeted therapies do not cause hair loss. However, this will depend on the drug and whether you are given it alongside other drug treatment like chemotherapy. Your specialist team will tell you if hair loss is a side effect of a targeted therapy they are recommending.

Radiotherapy

Like chemotherapy, radiotherapy affects healthy cells as well as cancer cells so can cause hair loss, but only in the specific area being treated. This means that you will only lose hair from that area. If you’re having radiotherapy to the lymph glands in your armpit as well as your breast you’ll lose underarm hair in the area that has been treated. Men with breast cancer having radiotherapy may lose chest hair from the part of their chest that has been treated.

If you are being given radiotherapy to the head to treat secondary breast cancer in the brain, you will lose some or all of the hair from your head. If you are having radiotherapy to the whole brain, this will usually cause complete hair loss on the head. The radiographer (person trained to give radiotherapy) or your clinical nurse specialist will talk to you about the likelihood of you losing your hair before treatment starts.

Hormone (endocrine) therapy

Taking hormone therapy  such as tamoxifen, anastrozole (Arimidex), exemestane (Aromasin) or letrozole (Femara) can cause hair thinning. This is usually mild and might only occur for a short time. However, in some cases it can continue throughout treatment, which can be many years. People don’t always tell their specialist team about hair thinning when they’re having hormone therapy so it’s difficult to say how common this is.

If you start hormone therapy after chemotherapy you may experience the effects on your hair from both types of treatment.

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5. Looking after your hair during breast cancer treatment

The following tips may be helpful for all hair types during treatment:

  • try not to wash your hair for about two days after chemotherapy, especially if having scalp cooling
  • use a mild, unperfumed shampoo and conditioner
  • try not to wash your hair more than twice a week
  • use warm rather than hot water
  • pat your hair dry rather than rubbing it
  • brush or comb your hair gently with a soft hairbrush or wide tooth plastic comb
  • avoid plaiting or braiding it as this may damage your hair
  • avoid using elastic bands to tie back long hair
  • avoid any hair colours and dyes, perms, relaxers and other products containing strong chemicals
  • avoid products containing alcohol, such as hairspray, which can irritate the scalp
  • avoid excessive heat from hair straighteners, hairdryers, hot brushes and heated rollers
  • massaging the scalp may help by improving the blood supply to the hair follicles
  • avoid hair extensions and weaves as these can also weaken the hair

If chemotherapy doesn’t cause hair loss, it may make it brittle, dry or straw-like, so it’s a good idea to treat your hair as gently as possible. Hormone therapy can also cause the hair to thin and feel fragile.

Due to its structure, African and Caribbean hair is the most vulnerable to damage of all hair textures so it is recommended to take special care and use specific products.

Hair thinning, poor condition or a dry and itchy scalp can also be related to poor diet, stress and drinking too much alcohol. Changes to your diet and lifestyle may help improve the condition of your hair.

If you lose your hair, read our tips on looking after your scalp after hair loss.

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6. Will I lose my eyelashes, eyebrows and body hair during chemotherapy?

Hair loss caused by chemotherapy can include the loss of all body hair, eyelashes and eyebrows.

Find out more about losing your eyelashes, eyebrows and body hair during chemotherapy.

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7. Can breast cancer treatment cause permanent hair loss?

Hair loss caused by chemotherapy is almost always temporary so hair will usually start to grow back once your treatment is over. Some people find that it starts to grow back before they have completed all their chemotherapy.

There is some evidence that chemotherapy may result in prolonged or permanent hair loss, particularly with taxane drugs (such as docetaxel or paclitaxel). Permanent hair loss is described as incomplete regrowth of hair six months or more after completing treatment.  

At the moment there is no definite evidence to say how often this happens, which may mean that this possible side effect is not included in written information given to patients undergoing chemotherapy.

As hair loss is common in both people with cancer and in the general population, it’s often difficult to be sure whether problems with hair regrowth are due to treatment, genetics or other factors such as extreme stress or medical conditions, or a combination of these things.

After radiotherapy, any hair that you lost from the treated area will usually grow back. You may find that the regrowth is patchy and it can take several months to grow back completely. It’s also possible that the hair may not grow back at all. This will depend on the dose of radiotherapy and the number of treatments you’ve had.

Once you have finished taking hormone therapy, your hair should return to how it was before treatment. However, this may take some time and for some may not fully return to the same thickness.

If you are concerned about hair loss when making decisions about treatment, talk to your oncologist and breast care nurse.

Treating long-term hair loss

If hair loss after treatment persists, you may wish to ask for advice from a specialist.

There are a few dermatologists (doctors who specialise in skin problems) who have a specialist interest in managing hair loss from various causes. They are able to offer information and advice to people experiencing hair loss. You can find the contact details of your nearest specialist on the British Hair and Nail Society website bhns.org.uk   

There are also a number of trichologists who may also offer advice. A trichologist is someone who specialises in hair loss problems but is not medically trained. The Institute of Trichologists are able to provide details of registered practitioners.

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8. What to expect if you lose your hair

Find out  what will happen if you lose your hair and how to prepare for it. 

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Last reviewed: December 2017
Next planned review begins 2019

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