# Hair loss and scalp cooling with breast cancer chemotherapy

Source: https://onco.cc/terms/hair-loss-and-scalp-cooling-breast/  
OnCo record `hair-loss-and-scalp-cooling-breast` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Taxane and anthracycline chemotherapy for triple-negative breast cancer causes hair loss in most people, usually starting after the first or second cycle and almost always growing back; scalp cooling kept more than half the hair in about half of women in a randomised trial and is offered in many UK units.

## Summary

In the SCALP randomised trial (Nangia 2017, JAMA) 50.5% of women cooled during taxane, anthracycline or both kept more than half their hair after the fourth cycle against 0% of controls. In the DigniCap cohort (Rugo 2017), which excluded anthracycline regimens, 66.3% kept at least half their hair. Macmillan says hair loss usually starts after the first or second treatment, that eyebrows and eyelashes can go too, that a wig is best fitted before treatment starts, and that hair usually starts to grow back after treatment, sometimes different in texture or colour. This is orientation from public patient pages and guidelines, not advice for your case: your own team's instructions and 24-hour number come first.

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: chemotherapy hair loss; cold cap

## Notes

- Whose hair the evidence describes. The randomised and cohort figures for scalp cooling come from trials with few Black participants. A later phase II study of the Paxman device in Black patients having chemotherapy for stage I to III breast cancer closed early after 15 of a planned 30 participants for lack of efficacy, with only one avoiding significant hair loss, and its authors named hair thickness, hair volume and cap design as the likely reasons. Anyone quoting a success rate of about one in two should say which population it came from.

## Sources

- Nangia et al., scalp cooling device and alopecia in women having chemotherapy for breast cancer, SCALP randomised trial (JAMA 2017): https://doi.org/10.1001/jama.2016.20939
- Rugo et al., scalp cooling and alopecia after chemotherapy for breast cancer, DigniCap cohort (JAMA 2017): https://doi.org/10.1001/jama.2016.21038
- Macmillan: hair loss: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/hair-loss
- Macmillan: sacituzumab govitecan: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/sacituzumab-govitecan
- Dilawari et al., does scalp cooling have the same efficacy in Black patients receiving chemotherapy for breast cancer? (The Oncologist 2021): https://doi.org/10.1002/onco.13690

## Connected records

- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/)
- technologies: [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/)
- drugs: [Epirubicin](https://onco.cc/drugs/epirubicin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/)

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