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Record ID: MS-N067 · Family: Supportive physical care / alopecia prevention · Clinical question: In people receiving chemotherapy for solid tumors, does scalp cooling preserve hair?

Evidence label: Effective for some regimens, but success is far from universal.

Evidence at a glance

  • Benefit: In the SCALP trial, about half of evaluable patients in the cooling group preserved enough hair to avoid a wig versus none without cooling.
  • Certainty: Moderate for selected breast-cancer regimens; response varies by drug, dose and cooling system.
  • Risk: Headache, cold discomfort and early discontinuation; long-term safety data are reassuring but cannot prove zero scalp-metastasis risk.
  • Cancer control: Not improved; the goal is hair preservation.

What was studied

The multicenter SCALP trial randomized 182 women with stage I or II breast cancer receiving anthracycline- or taxane-based chemotherapy to scalp cooling (119) or no cooling (63). The primary outcome was clinician-rated hair preservation after four cycles, defined as grade 0 or 1 alopecia without needing a wig. The primary evaluable population was 95 versus 47.

Later systematic reviews and safety analyses were checked because effectiveness varies substantially across regimens and because scalp-metastasis concern is clinically important.

What the results show

Hair preservation occurred in 48 of 95 evaluable participants with cooling (50.5%; 95% CI 40.7%–60.4%) and 0 of 47 controls (0%; 95% CI 0%–7.6%). The absolute difference was 50.5 percentage points (95% CI 40.5–60.6). The study stopped early for superiority. Quality-of-life measures did not clearly differ.

The trial reported mild headache and cold discomfort; three participants stopped because they felt too cold. A 2025 safety meta-analysis estimated scalp-metastasis incidence after cooling at 0.15% (95% CI 0.05%–0.47%), mostly from breast-cancer cohorts. That low estimate does not establish zero risk or equal safety in every cancer.

Limits and uncertainty

The primary analysis excluded many randomized participants because they did not have an assessable endpoint, and the trial was not blinded. Success depends on chemotherapy, fit, temperature, pre- and post-infusion cooling time, hair characteristics and the outcome definition. Evidence is strongest in breast cancer and some taxane regimens, not all solid tumors. Manufacturer involvement and full conflict details should be reviewed in the publication.

Safety and practical context

Scalp cooling is generally avoided in hematologic malignancies and may be inappropriate with known scalp involvement, cold-related disorders, cryoglobulinemia or severe cold intolerance. It can prolong infusion-center time and may cause headache, dizziness or skin discomfort. Decisions should follow the oncology center’s protocol; cooling should not change an effective chemotherapy plan solely to preserve hair.

Questions for the care team

  • Is scalp cooling appropriate for this cancer type and exact chemotherapy regimen?
  • What hair-preservation rate does this center see with the same device and regimen?
  • Are there cold-related conditions, scalp disease or disease-distribution concerns that make it unsafe?

Sources checked

Last literature search: October 18, 2026 · Record appraisal: October 18, 2026

Educational evidence summary, not personal medical advice. This record concerns symptom or supportive care. It does not establish tumor shrinkage, recurrence prevention or longer survival, and it should not delay or replace oncology treatment.