Breast cancer is the most common type of cancer among women, accounting for around 30% of all cancers. A breast cancer diagnosis is a life-altering event that can have a massive impact on the mental and emotional well-being of most women regardless of their age.
Psychological distress can appear in the form of depression, anxiety, fear, and panic, with more than 50% of individuals experiencing severe distress. Common stressors include fear of mortality, dealing with family, financial concerns, and fears about treatment side effects.
Due to social conditioning, many women are often highly apprehensive about the impact breast cancer treatment can have on their bodies and appearance. The loss of a breast to mastectomy is a major concern. However, not all breast cancer cases require surgical interventions.
Hair loss is a far more common side effect that affects around 65% of all chemotherapy patients. Called chemotherapy-induced alopecia or CIA, it is often overlooked as a minor aspect of dealing with cancer. However, research indicates it can have severe implications, especially for women.
A recent study by researchers at NYU Langone Health, a premier academic medical center in New York City, explored the possibility of using oral minoxidil to treat hair loss in chemotherapy patients. The results were published in the Journal of the American Academy of Dermatology.
The Crippling Psychosocial Effects of Alopecia in Breast Cancer Patients
Numerous studies in recent decades have explored the impact of CIA on women undergoing breast cancer treatment. They unequivocally highlight hair loss as one of the most traumatic experiences of the chemotherapy experience for women.
CIA happens visibly over time, with affected patients losing most or all of their hair within a few weeks or months of starting the treatment. This can lead to intense feelings of depression, loss of self-confidence, and the inability to deal with social situations in many affected individuals.
Hair is strongly associated with gender, health, and femininity and it often acts as a core aspect of a woman’s identity. While many women find ways to cope with alopecia, in extreme cases it can even cause individuals to become reluctant about getting appropriate treatment.
The Mechanism Behind Chemo-Induced Alopecia
One of the hallmarks of cancer cells is rapid cell division, which leads to aggressive tumor growth. Rapid cell division is a natural cellular phenomenon that involves various processes like DNA replication, cell cycle regulation, RNA transcription, protein synthesis, DNA repair, and so on.
Chemotherapy drugs attempt to shut down rapid cell division by targeting these processes. Unfortunately, these drugs also end up affecting otherwise healthy cells that routinely undergo quick cell division.
Cells in the bone marrow, digestive tract, and hair follicles are all naturally designed to rapidly multiply, making them prone to collateral damage during chemotherapy. This is why hair loss, anemia, and digestive issues are among the most common side effects of chemotherapy.
Many of these side effects can be combated by other medications. For instance, physicians often prescribe ant-nausea medication to patients who undergo chemotherapy. Likewise, CIA can also be combated with a drug that has been around for several decades – minoxidil.
An Overview of Minoxidil and its Mode of Action
In the late 1950s, the Upjohn Company was attempting to find a treatment for peptic ulcers. One of the compounds they investigated was found to have a powerful vasodilatory effect in animal studies. So, they developed it into an oral medication for blood pressure.
Subsequent studies showed that the drug also had an unexpected side effect – hair growth. By the 1980s, doctors started prescribing minoxidil off-label as a preventive medicine for baldness. Eventually, FDA approval arrived in 1988 with the brand name “Rogaine.”
Available for both men and women, minoxidil helps counter hair loss in several different ways. Although we don’t yet fully understand how the medication works, we do know the following facts:
- Minoxidil prolongs the growth phase (anagen phase) in hair follicles.
- Being a vasodilator, it also widens blood vessels, improving the delivery of nutrients and oxygen to hair follicles.
- It can also enhance follicle function and size by triggering potassium channel opening.
While these capabilities allow minoxidil to combat and prevent certain forms of alopecia, like male pattern baldness, it cannot prevent CIA. However, it can significantly shorten the time it takes for the hair to grow back after the treatment phase.
Over the years, doctors have been somewhat wary about prescribing minoxidil to chemotherapy patients. In cancer patients, it could lead to multiple complications including dizziness, fainting, and irregular heartbeat. By lowering the blood pressure, it can put additional strain on the heart.
Implications of the NYU Langone Health Study for Breast Cancer Patients
In the study, researchers looked at breast cancer patients who were treated at NYU Langone Health between 2012 and 2023. Out of hundreds of women, 51 had been given oral minoxidil for periods longer than one month. The shortlist included women from diverse age groups and races.
All the women had undergone chemotherapy, either on its own or alongside some type of surgical intervention. The data included both patient reports and doctor assessments. After a thorough review, the study arrived at the following conclusions:
- In low doses, minoxidil does not cause any serious side effects in chemotherapy patients.
- The drug is also effective in improving hair growth within three to six months.
- In some women, it stabilized the hair loss caused by chemotherapy.
The results indicate that breast cancer patients may not have to wait until the end of chemotherapy to take minoxidil for CIA. The promise of a faster recovery from alopecia can help boost self-confidence and reduce the initial stress caused during the first rounds of chemo.
According to the authors, the study does have a few limitations, since it relied on both medical reports and patient self-assessments. At least in some instances, patients may not have recognized minor symptoms of cardiac distress.
There is no doubt that the study is a step in the right direction. Additional research with a wider scope is needed to see if minoxidil can be deployed to help patients who are suffering from other forms of cancer, across all genders.
