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Scalp Cooling Safe

Posted 8/28/2013

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  For many women, the hair loss associated with chemotherapy is almost the worst (or, sometimes, the very worst) part of the whole experience. This was a major topic of conversation in my group yesterday for women who are currently going through adjuvant chemotherapy. One woman has just lost her hair, and another is anticipating the "fall out" this week. It is awful, always, for everyone. No question about it. Although some women insist that they don't care "too much" and adjust fairly easily, I have never met anyone who wasn't traumatized to a greater or lesser degree by new baldness.

  I have written before about the reappearance (they were around twenty or so years ago) of ice caps to wear during chemo to prevent or reduce hair loss. There have been several issues about their use: whether they are safe (e.g. does preventing normal blood flow to the scalp increase the chances of developing skin/scalp mets?), how uncomfortable they are to use, and the high cost. The second and third questions are unresolved, but this study from The Breast is reassuring about their safety.

  Over the past month, I have seen these new caps in use twice. One woman was here for her first treatment, so we don't know how effective it was/will be in helping her keep her hair. The second woman had already had several chemotherapy cycles and, yes, she did have some hair.....but it looked pretty sparse and awful. To my eyes (and everyone is surely entitled to her own opinion here), she would have looked better bald/scarved/hatted/wigged than she did with some bald patches and some straggly clumps of hair. Insurance does not cover the cost of these caps, and they are thousands of dollars per use.

  Here is the abstract from this recent study about safety .

Scalp cooling to prevent alopecia after chemotherapy can be considered safe in patients with breast cancer
C.J.G. van den Hurk a,*, L.V. van de Poll-Franse a,b, W.P.M. Breed a, J.W.W. Coebergh a,
J.W.R. Nortier c

a b s t r a c t
With modern scalp cooling equipment cytotoxic damage of hair root cells can be prevented in half of the
patients with cancer at high risk of alopecia. However, traditionally doubt has existed whether scalp
cooling might facilitate hiding and disseminating scalp skin metastases and thus decrease survival. We
discuss this risk using frequency data on metastases in breast cancer from observational and autopsy
studies and the Munich cancer registry. They showed the incidence of scalp skin metastases to be very
low and not differ between scalp-cooled (0.04e1%) and non scalp-cooled (0.03e3%) patients with breast
cancer and in need of chemotherapy. We found it rather unlikely that the incidence of scalp skin metastases
might increase at all after scalp cooling, whereas a very small proportion of patients receiving
chemotherapy are at risk to develop metastases at this site. Scalp cooling can thus safely be offered to
patients treated with alopecia-inducing chemotherapy.

 

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