Deanna Denham Hughes was stunned when she was diagnosed with ovarian cancer last year. She was only 32. She had no family history of cancer and tests found no genetic link. Hughes wondered why she, an otherwise healthy black mother of two, would develop a malignant disease known as the “silent killer.”
After emergency surgery to remove the mass, along with her ovaries, uterus, fallopian tubes and appendix, Hughes said, she saw an Instagram post in which a woman with uterine cancer linked her condition to chemical hair straighteners.
“I almost fell over,” she said from her home in Smyrna, Georgia.
When Hughes was about 4 years old, her mother began applying a perm or relaxer to her hair every six to eight weeks. “It burned and it smelled terrible,” Hughes recalled. “But it was just part of our routine to ‘do our hair’.”
The routine continued until she went to college and met other black women who wore their hair natural. Hughes soon left the relaxers.
Social and economic pressures have long forced black girls and women to straighten their hair to meet Eurocentric standards of beauty. But chemical presses are smelly and expensive and sometimes cause painful scalp burns. Growing evidence now shows that they may pose a health hazard.
Relaxers may contain carcinogens, such as formaldehyde-releasing agents, phthalates and other endocrine-disrupting compounds, according to research by the National Institutes of Health. The compounds can mimic the body’s hormones and have been linked to breast, uterine and ovarian cancer, studies show.
African American women’s frequent and lifelong application of chemical relaxers to their hair and scalp may explain why hormone-related cancers kill disproportionately more black women than white women, cancer researchers and doctors say.
“What’s in these products is harmful,” said Tamara James-Todd, a professor of epidemiology at the Harvard TH Chan School of Public Health who has studied straightening products for the past 20 years.
She believes manufacturers, politicians and doctors should warn consumers that relaxers can cause cancer and other health problems.
But regulators are slow to act, doctors are reluctant to take up the cause, and racism continues to dictate fashion standards that make it difficult for women to give up the relaxers, products so addictive they’re known as “creamy crack.”
Black women weigh in on the emerging risks of ‘Creamy Crack’ hair straighteners.
Michelle Obama straightened her hair when Barack was president because she believed Americans were “not ready” to see her with braids, the former first lady said after leaving the White House. The US military still banned popular black hairstyles like dreadlocks and twists while the nation’s first black president was in office.
California in 2019 became the first of nearly two dozen states to outlaw hair discrimination based on race. Last year, the US House of Representatives passed similar legislation, known as the CROWN Act, to create a respectful and open world for natural hair. But the bill failed in the Senate.
The need for legislation highlights the challenges black girls and women face in school and in the workplace.
“You have to pick your fights,” said Atlanta-based surgical oncologist Ryland Gore. She informs her breast cancer patients about the increased risk of cancer from relaxers. Despite his knowledge, however, Gore continued to use chemical presses on his own hair, as he had done since he was about 7 years old.
“Your hair tells a story,” she said.
In conversations with patients, Gore also sometimes talks about how African-American women once wove messages into their braids about the route they would take on the Underground Railroad as they sought freedom from slavery.
“It’s just an in-depth discussion” that touches on the culture, history and research of current hairstyle practices, she said. “The data is there. So patients should be warned and then they can make a decision.”
The first hint of a link between hair products and health problems appeared in the 1990s. Doctors began to see signs of puberty in black infants and young girls who developed breasts and pubic hair after using shampoo containing estrogen or placenta extract. When girls stopped using the shampoo, hair and breast development decreased, according to a study published in the journal Clinical Pediatrics in 1998.
Since then, James-Todd and other researchers have linked chemicals in hair products to a variety of health problems more prevalent among black women, from early puberty to premature birth, obesity and diabetes.
In recent years, researchers have focused on a possible link between ingredients in chemical relaxants and hormone-related cancers, like the one developed by Hughes, which tend to be more aggressive and deadly in black women.
A 2017 study found that white women who used chemical relaxants were almost twice as likely to develop breast cancer as those who did not. Because the majority of black study participants used relaxants, the researchers could not effectively test the link in black women, said lead author Adana Lanos, an associate professor of epidemiology at Columbia University’s Mailman School of Public Health.
Researchers tested it in 2020.
The so-called Sister Study, a landmark National Institute of Environmental Health Sciences study of the causes of breast cancer and related diseases, followed 50,000 US women whose sisters were diagnosed with breast cancer and who were cancer-free , when they turned on. Regardless of race, women who reported using relaxants in the previous year were 18% more likely to be diagnosed with breast cancer. Those who used relaxants at least every five to eight weeks had a 31 percent higher risk of breast cancer.
Nearly 75% of black nurses had used relaxers in the previous year, compared with only 3% of non-Hispanic white nurses. Three-quarters of black women also report using presses as teenagers, and frequent use of chemical presses during adolescence increases the risk of breast cancer before menopause, a 2021 NIH-funded study in the International Journal of Cancer found.
Another 2021 analysis of data from the Sister Study found that sisters who self-reported frequent use of relaxing or pressing products doubled their risk of ovarian cancer. In 2022, another study found that frequent use more than doubled the risk of uterine cancer.
After researchers discovered the link to uterine cancer, some called for policy changes and other measures to reduce exposure to chemical relaxants.
“It’s time to intervene,” Llanos and her colleagues wrote in the Journal of the National Cancer Institute editorial accompanying the uterine cancer analysis. While acknowledging the need for more research, they issued a “call to action.”
No one can say that using perms will give you cancer, Llanos said in an interview. “Cancer doesn’t work like that,” she said, noting that some smokers never develop lung cancer, even though tobacco use is a known risk factor.
Research linking hair curlers to cancer is more limited, said Llanos, who stopped using chemical relaxers 15 years ago. But she asked rhetorically, “Do we have to do research for another 50 years to know that chemical relaxants are harmful?”
Charlotte Gamble, a gynecologic oncologist whose Washington, D.C., practice includes black women with uterine and ovarian cancer, said she and her colleagues see the results of the uterine cancer study as worthy of further study — but still not yet worthy of discussion with patients.
“Personally, the jury is out for me,” she said. “There is so much more data that is needed.”
Meanwhile, James-Todd and other researchers believe they have built solid evidence.
“There is enough that we know to begin to take action, to develop interventions, to provide useful information to clinicians and patients and to the general public,” said Tracy Bethea, an assistant professor in the Office of Minority Health and Health Disparities Research at Georgetown University.
Responsibility for regulating personal care products, including chemical hair straighteners and hair dyes — which have also been linked to hormone-related cancers — rests with the Food and Drug Administration. But the FDA doesn’t subject personal care products to the same approval process it uses for food and drugs. The FDA restricts only 11 categories of chemicals used in cosmetics, while concerns about health effects have led the European Union to restrict the use of at least 2,400 substances.
In March, Reps. Ayanna Pressley (D-Mass.) and Shontel Brown (D-Ohio) asked the FDA to investigate the potential health threat posed by chemical relaxants. An FDA official said the agency would look into it.
Natural hairstyles are enjoying a resurgence among black girls and women, but many continue to rely on creamy crack, said Dede Teteh, an assistant professor of public health at Chapman University.
She got her first straightening curl at 8 and struggled to pull back from relaxers as an adult, said Teteh, who now wears curls. She recently considered having her hair chemically straightened for an academic job interview because she didn’t want her hair to “get in the way” when she appeared in front of white professors.
Tete led The Price of Beauty, a research project on hair health published in 2017. She and her team interviewed 91 black women in Southern California. Some became “combative” at the idea of giving up relaxers and claimed that “anything can cause cancer.”
Their reactions speak to the challenges black women face in America, Teteh said.
“It’s not that people don’t want to hear information related to their health,” she said. “But they want people to share the information in a way that’s really empathetic to the plight of being black here in the United States.”
Kara Nelson of KFF Health News contributed to this report.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.