If hair doesn't grow back
Persistent Chemotherapy Induced Alopecia (pCIA)
It is well known that chemotherapy treatment for breast cancer can cause temporary hair loss. This is known as Chemotherapy Induced Alopecia, CIA. It is understood by most patients and that once chemotherapy has finished the hair will regrow. However, there is growing evidence that for some patients the hair never returns to its pre-treatment growth pattern.
Many oncologists and clinical teams may dismiss concerns of pCIA as “rare” and you may feel intimidated to voice your concerns. If your treatment plan includes Taxane based chemotherapy the risk of pCIA is higher compared with patients with other regimes. The risks of pCIA can be increased with patients with hormone therapy. Hormone therapy is antiestrogenic, a substance that keeps cells from making or using estrogen. Estrogen is a hormone that plays a role in female sex characteristics, the menstrual cycle and pregnancy. Antiestrogens may stop cancer cells from growing and are used to prevent and treat breast cancer. A recent study between the Clatterbridge cancer centre and Christie NHS Foundation showed a huge spike in pCIA occurring in post-menopausal women (37.8%)
Why is the hair affected?
Why is the hair affected?
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Taxanes prevent cell division. Hair cells are one of the fastest dividing cells in the body similar to cancer cells and the chemotherapy drugs are designed to attack these fast-dividing cells and that is why the hair suffers during treatment. This can affect hair on all parts of the body including eyebrows and eyelashes.
Hair loss is one of the most feared side effects of treatment.
A good head of hair is a key element of good health and beauty. It gives us our identity. CIA has a significant impact on one’s self esteem, body image, sexuality and quality of life. For most patients this will be temporary, and your hair will return, within a year following the end of treatment, all be it with a change in colour or texture.
CIA and pCIA can also be seen as a public sign of one’s illness. The visibility of alopecia makes it difficult for patients to keep their cancer status private. Patients’ perception of others attitude may change from sympathy to rejection.
pCIA is diagnosed when there is in no sign of regrowth or incomplete hair growth six months after completing treatment. The appearance can look similar to that of Androgenic Alopecia with more hair to the sides and back of the head and less on the top of the scalp.
Treating pCIA
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CIA and pCIA can be prevented by scalp cooling.
Cooling the scalp restricts the blood vessels in the scalp reducing the cell activity, so no longer fast active cell division, and the amount of the drug that reaches the follicle.
Scalp cooling does not guarantee no hair loss, some shedding will occur even for those with good retention. However, for those patients receiving Taxotere/Docetael scalp cooling has been proven to prevent pCIA. Scalp cooling has also been proven to ensure faster and healthier hair regrowth, regardless of hair retention, after treatment.
“Ahead of our time” is a world-wide organisation supporting women with pCIA. By working with dermatologists, oncologists and fellow sufferers they offer emotional support, education and updates on medical research into this devastating condition.
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Elizabeth Smith
ART/USTI
Trichologist
March 2024
Useful Videos
Our friend, Jo Knight received chemotherapy as part of her cancer diagnosis and has recently been recognised has having pCIA. Jo's hair has not grown back as she expected. Following a visit to Novo Cabelo Hair, Jo has been fitted with a new hair system, which will last for three to four months with the right care. Please see the videos below for Jo's story. With thanks to Jo Knight and Rob Wood Instagram: @prelovedrel0ved Instagram: @tit_less_wonder https://novocabelo.co.uk/ Instagram - @novocabelohair Tiktok - @novocabelohair Facebook - @novocabelohair.co.uk
