The first time Miriam Lipton had breast cancer, her thick locks fell out two weeks after starting chemotherapy. The second time breast cancer struck, Lipton gave her scalp a deep chill and kept much of her hair — making her fight for survival seem a bit easier.

Hair loss is one of chemotherapy's most despised side effects, not because of vanity but because it fuels stigma, revealing to the world an illness that many would rather keep private.

"I didn't necessarily want to walk around the grocery store answering questions about my cancer," recalled Lipton, 45, of San Francisco. "If you look OK on the outside, it can help you feel, 'OK, this is manageable, I can get through this.'"

Now U.S. researchers are about to put an experimental hair-preserving treatment to a rigorous test: To see if strapping on a cap so cold it numbs the scalp during chemo, like Lipton did, really works well enough to be used widely in this country, as it is in Europe and Canada.
Near-freezing temperatures are supposed to reduce blood flow in the scalp, making it harder for cancer-fighting drugs to reach and harm hair follicles. But while several types of cold caps are sold around the world, the Food and Drug Administration hasn't approved their use in the U.S.

Scalping cooling is an idea that's been around for decades, but it never caught on here in part because of a concern: Could the cold prevent chemotherapy from reaching any stray cancer cells lurking in the scalp?

"Do they work and are they safe? Those are the two big holes. We just don't know," said American Cancer Society spokeswoman Kimberly Stump-Sutliff, an oncology nurse who said studies abroad haven't settled those questions. "We need to know."

To Dr. Hope Rugo of the University of California, San Francisco, the impact of hair loss has been overlooked, even belittled, by health providers. She's had patients delay crucial treatment to avoid it, and others whose businesses suffered when clients saw they were sick and shied away.