A breast cancer diagnosis brings up a lot of questions about the future of your health. You’ll want to know more about the treatment you’ll have and any expected side effects.

Chemotherapy, a common breast cancer treatment, causes temporary hair loss for women of all races and ethnicities. But those with Afro-textured hair face unique challenges on their cancer journey.

The Science of Black Hair

Many people of African descent have naturally curly hair ranging from tightly coiled hair to looser rings. If you look at a strand of this type of hair under a microscope, you’d see it’s flat, twisty, and thin. The twists have natural break points, kind of like a straw when you bend it.

These bends, and a natural tendency to form knots, make curly hair more fragile. Sebum, a natural moisturizer made in your oil glands, has trouble moving down the shaft of curly hair, potentially leaving it drier and more prone to breakage.

Hairstyles like braids, weaves, and wigs sometimes make hair weaker and more likely to break. Researchers also link the heavy use of lye relaxers, which some Black women use to permanently straighten their hair, to hair damage, and possibly higher rates of breast cancer.

Breast Cancer Treatment and Black Hair

A breast cancer diagnosis could mean the loss of your hair. Chemotherapy drugs damage hair follicles, causing locks to fall out in clumps when you wash or comb them.

For some Black women, hair is an expression of identity -- from personal to cultural, and even political. Janine Pettiford, MD, a surgical breast oncologist with Northside Hospital in Atlanta, says when her patients learn they’ll need chemotherapy, their first question is often about hair loss. She reminds them, “It’s only temporary. In the bigger scheme of things chemo is helping to control your disease so it doesn’t progress.”

Everyone responds to chemo in different ways. You could lose your hair, it may become thinner, or it’s possible you’ll keep all of your hair. If you do lose your hair, expect it to start 1 to 3 weeks after your first chemo treatment.

Preparing Your Hair for Chemotherapy

You may wear braids, wigs, and weaves to express your personal style and protect your hair from styling damage and natural elements like humidity. But wearing them during chemo could put extra stress on your scalp.

Chemotherapy drugs may make your scalp sensitive, sore, and itchy. This discomfort should get better a few days after starting treatment. But if you’re wearing braids or other protective styles, the added tension can feel even worse on your scalp. And, the tugging required to take out braids and weaves may be especially painful during chemotherapy. Think about removing hair extensions before starting your chemo treatments to protect your sensitive scalp.

Cooling Caps and Black Hair

Cooling the scalp (called scalp hypothermia) is a way to preserve your hair during chemotherapy. Health care professionals use ice packs or a special cap that holds a cooled liquid. You’ll wear a second cap on top to keep in the cold. Experts think cooling narrows blood vessels in the scalp, slowing the amount of chemo drugs that make it to hair follicle cells.

Research is mixed about whether cooling caps work on textured hair. Some studies show thick, curly hair may not respond as well to scalp cooling. Scientists need to carry out larger, more diverse studies to learn how hair texture affects how well this therapy works.

If you decide to try a cooling cap, keep these tips in mind:

You’ll need to remove hair extensions or wigs before treatment. Small twists or braids without extensions are probably OK to wear.
Be sure to let your nurse know your natural hair type so they can offer treatment suggestions.
Coily hair may need extra time under a cooling cap since it can be denser than other hair types and longer than it appears.
Some experts suggest temporarily straightening naturally curly hair and applying hair grease to help it lie flat under a cooling cap.

Your nurse could ask you to wash and condition your hair with products that come with the cooling device and leave your hair wet for better contact between the cap and your scalp. Bring up any concerns you have about certain hair products, and tell them how water changes your hair -- for example if water makes your hair too curly or large to fit under the cap.

Health care professionals don’t always know that cooling caps are OK to use on Afro- textured hair. Talk to your cancer care team and let them know you’d like to use one.

Wigs for Black Hair Loss

Wearing a wig during or after cancer treatment can help you feel more like yourself until your own hair grows back.

Bethany Golden is the owner of the Over My Head Cancer Care Boutique at OhioHealth, which provides wigs, hair coverings, and cold cap therapy for people with cancer. She says some women who use her services worry about appearing vain. “I don't think saving hair is about vanity at all. I think it's about keeping normalcy in your life in a situation where you don't have any control.”

Wigs for hair loss are different than the ones for everyday use. They have special adhesives that help them stay attached to your scalp.

Unfortunately, Black women with tightly curled hair have a harder time finding hair loss wigs that match their natural texture and color. Businesses like Coils to Locs, co-founded by a cancer survivor, cater to Black women with hair loss, but they’re few and far between.

Wigs for hair loss can also be expensive, ranging from $200 to $1,000. Hand-tied wigs -- where the wig maker attaches each strand of hair by hand -- are the most versatile type. They’re more breathable, natural-looking, and offer a better match for your skin tone underneath the wig. But, they’re also pricier than other kinds of wigs.

Neither Medicare nor Medicaid cover the cost of wigs for people with cancer, while private health insurance could only cover a small amount. To bring the cost down, choose a wig made of synthetic hair instead of human hair. It’s also possible to deduct the expense from your taxes. Online groups for Black women living with cancer are another resource for finding custom wigs.

Caring for Your Scalp and Hair

Your scalp and new hair growth need extra care during cancer treatment and beyond. Keep these tips in mind:

Sun protection. Brown skin has more melanin, which offers natural protection from sun damage. You still need sunscreen, though, especially when you’ve lost your hair. Apply a broad-spectrum sunscreen with an SPF of at least 30, and be sure to cover up with a hat.
Hair oils. If you typically use natural oils like coconut oil to moisturize your hair, apply them sparingly during cancer treatment. Your bare scalp has a harder time absorbing oil and can make new hair growth look sparse.
Styling. As your hair begins to grow back in after chemotherapy, be careful with hair extensions, wigs, chemical relaxers, and hair dye. Fragile new hair growth needs more time to bounce back without added stress. Wait until you have 2 to 4 inches of new growth before making any major changes.

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Hair Loss and Breast Cancer Among Black Women