OR WAIT null SECS
Racial Disparities in Persistent Chemotherapy-Induced Alopecia Observed in Women
Investigators observed disparities in race with persistent chemotherapy-induced alopecia among women with breast cancer.
Significant racial and ethnic disparities have been observed in both incidence and psychological impacts of persistent chemotherapy-induced alopecia (PCIA), new data suggest, with Asian women experiencing the greatest burden.1
These new data, published in JAMA, were authored by such investigators as Juhee Cho, PhD, from the Department of Clinical Research Design and Evaluation at the Samsung Advanced Institute for Health Sciences and Technology. Cho and colleagues noted the distressing nature of hair loss as an adverse effect of chemotherapy.
Chemotherapy-induced alopecia is commonly considered to be a temporary condition, yet Cho and coauthors highlighted the subset of patients who sometimes experience incomplete or absent scalp hair regrowth, which can persist for months or even years.2 This condition is PCIA, and the investigators also pointed to a previous lack of racial and ethnic difference data regarding the condition’s incidence.
“[We] conducted a prospective multinational cohort study of patients with nonmetastatic breast cancer who were receiving cytotoxic chemotherapy,” Cho et al wrote.1 “Using standardized scalp imaging and a validated distress scale, we compared PCIA incidence and alopecia-related psychological distress among Asian, Black, Hispanic or Latino, and White women.”
Study Design Details
The investigative team used data from 2 cohorts: the CHANCE (Chemotherapy-Induced Hair Changes and Alopecia, Skin Aging and Nail Changes in Women With Non-Metastatic Breast Cancer) prospective cohort analysis (NCT02530177) from the US and the CHANCE Korea twin cohort study performed in South Korea.
The CHANCE study was conducted at Memorial Sloan Kettering Cancer Center, with investigators seeking to quantify PCIA incidence in adult women with breast cancer on cytotoxic chemotherapy as well as endocrine therapy. The CHANCE study involved 100 patients enrolling in each of the 5 treatment cohorts, with the target being 600 participants across 3 treatment arms: 300 anticipating chemotherapy, 200 anticipating endocrine therapy exclusively, and 100 not planning adjuvant therapy.
In the CHANCE Korea study, conducted at Samsung Medical Center in South Korea, investigators also sought to quantify the incidence of PCIA and alopecia in adult women with breast cancer on cytotoxic chemotherapy and endocrine therapy. Patients were recruited between August 2015 and December 2021, with the final follow-up being completed in 2021. This analysis involved 50 patients being enrolled in each of the 5 treatment arms and 50 patients being without any treatment.
CHANCE Korea aimed to involve 300 individuals, with a target of 150 anticipating receiving chemotherapy, 100 anticipating endocrine therapy exclusively, and 50 planning not to receive adjuvant therapy. Between December 2018 and April 2022, patients were recruited, with the last follow-up being finished in 2022.
Both cohorts did not include those reporting other causes of hair loss. Thus, in Cho and colleagues' final analytic sample, only those without any prior hair problems who were given chemotherapy and completed the 12-month follow-up assessments were included. The investigative team implemented standardized trichoscopic assessments. Validated distress questionnaires were administered to subjects at both baseline and the 12-month mark following treatment.
The investigators' main outcome evaluated was PCIA incidence, defined by the team as hair thickness or density at 12 months following chemotherapy's completion that fell more than 2 SDs below the level observed prior to treatment. In terms of secondary outcomes, Cho and coauthors looked at any changes in hair shaft thickness, hair density, and alopecia-related distress determined via the Chemotherapy-Induced Alopecia Distress Scale (CADS).
New Findings on PCIA in Women with Breast Cancer
There were 304 women, with a mean age of 50.3 years, involved in Cho et al's analysis. They were shown to be 52.3% Asian, 6.6% Black, 5.6% Hispanic or Latino, or 35.5% White. At the point of baseline, Asian women were observed to have the thickest hair shafts but the lowest follicular density (P < .001).1 By the 12-month mark, incidence of PCIA was shown to be the highest among Asian women (P = .001). Specifically, incidence of PCIA was:
- 42.1% among Asian women
- 22.2% among White women
- 10.0% among Black women
- 5.1% among Hispanic or Latino women
Additionally, Asian women were also shown to have the greatest increase in CADS scores versus White women.1 This was especially the case in the emotional domains (adjusted mean difference, 1.88 [95% CI, 0.92-2.95]) and activity-related (1.55 [95% CI, 0.58-2.52]) domains.
“The high incidence and emotional burden observed among Asian women exemplified how biological vulnerability and cultural pressure could intersect and magnify health consequences,” the investigative team concluded.1 “Addressing PCIA requires an integrative, interdisciplinary approach that acknowledges both the molecular and meaning-centered aspects of hair loss.”
References
Kang D, Kraehenbuehl L, Lee H, et al. Racial and Ethnic Disparities in Persistent Chemotherapy-Induced Alopecia Among Women With Breast Cancer. JAMA Netw Open. 2026;9(1):e2549146. doi:10.1001/jamanetworkopen.2025.49146.
Kluger N, Jacot W, Bessis D, et al. Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: a prospective study of 20 patients. Ann Oncol. 2012 Nov;23(11):2879-2884. doi: 10.1093/annonc/mds095. Epub 2012 May 9. PMID: 22571858.
