When the groundbreaking study Use of Straighteners and Other Hair Products and Incident Uterine Cancer1 was released last fall, my environmental health colleagues and I rejoiced. Several studies had previously identified links between hair products and breast cancer.2–7, 8–11 But this was the first study showing the strong (and long suspected) links to uterine cancer.
The study1 took a deep dive into data from nearly 34,000 women aged 35 to 74 and followed them for about 11 years. Women were asked about their use of hair products, including hair dyes, straighteners, relaxers, pressing products, and permanents or body waves. Researchers identified 378 cases of uterine cancer and noted that hair straighteners were most strongly associated with uterine cancer. Women who used these products more frequently had a higher risk of contracting uterine cancer.1
But this isn’t news to naturopathic doctors, who have long been aware of the health risks posed by endocrine-disrupting chemicals in personal care products. Dr. Jessica Tran, ND, FAAEM, is a board-certified environmental doctor with extensive environmental medicine training. She co-founded the National Association of Environmental Medicine and is the Continuing Medical Education Chair of the American Academy of Environmental Medicine. Her goal as a naturopathic doctor is to provide hope, health, and healing – and that includes helping patients reduce their toxic exposures to improve overall health and reduce chronic disease risk.
Tran notes that where conventional medicine typically considers the impact of environmental toxins on health as a workplace issue (those working in mines, chemical factories, etc.), naturopathic medicine takes into account the effect of toxins we are exposed to in all areas of life. “It’s the low-level accumulation over time that develops and affects our health. And it’s our ability to handle this toxicant load,” Tran notes. Her approach involves looking at genetics to assess each person’s natural ability to get toxins out of the body and evaluating the home, diet, and lifestyle to learn where and how they may be exposed to toxins to help patients reduce their exposures.
Regarding hair straighteners, Tran points to the beauty standard connection. “Why are we doing this to ourselves? We’re trying to attain this image, but the conversation needs to be moved forward to embrace the assets we are blessed with rather than trying to alter ourselves. From an environmental perspective, we’re harming ourselves.”
Tran admits that this subject matter can be doom and gloom, but that’s the last thing she wants her patients to experience. “We don’t want people to feel hopeless. Building immune resiliency reduces your toxic load so that you can handle your environment better,” Tran explains. “That’s what you get when you speak to a naturopathic doctor: building your immune resiliency and understanding how your environment affects your health, sleep, human connection, and the foods you consume.”
I was pleasantly surprised to see major news outlets covering this story.12,13 Traditionally, mainstream media hasn’t been all that interested in covering stories related to health equity. However, I believe this study hit a collective cultural nerve because this isn’t just about switching to a new hair product. As Tran alluded, this issue gets to the heart of how colonial beauty standards impact health, employment status, mental health, and more.
Although many chemicals are involved, formaldehyde (FA) deserves a closer look. FA is a common ingredient in hair straightening products. The International Agency for Research on Cancer (IARC) considers formaldehyde a cancer-causing chemical for humans.14
But when heat is added (think blow dryers and flat irons), more FA is produced, raising the risk of taking in higher levels through the skin and by inhalation. 14 Continuous and delayed exposure to FA is linked to a wide range of major health issues, including allergies, genetic mutations, skin cancer, and sinus cancer. Prolonged exposure to FA at a high intensity increased the likelihood of myeloid leukemia progression.15
Compared to other racial/ethnic groups, black women have some of the highest quantities of these personal care product chemicals, with hair products perhaps being a significant source of exposure to hormonally active compounds. 16
When it comes to what it means to look ‘professional’ in the North American workplace for Black people, hair can be a battleground. There is intense pressure to comply with Eurocentric beauty standards that favor straight hair. But this isn’t just about how Black women are generally perceived in the workplace. Consequences of wearing a ‘natural’ hairstyle can include not being hired, being passed over for promotions, or even being asked to change their hairstyle.
The use patterns of hair care products are rooted in longstanding racial stereotypes towards Black individuals. The author of a 2021 study17 notes that racist assumptions about Black people’s “intellect and social refinement” are often strongly linked to hair texture and styling.17
Earlier this year, Dove and LinkedIn co-commissioned the 2023 CROWN Workplace Research Study, detailing the systemic social and economic impact of hair bias and discrimination against Black women in the workplace in 2023.18 Although I regularly review research related to workplace equity, even I was shocked at these stats.
Researchers found that Black women’s hair is 2.5 times more likely to be perceived as unprofessional in the workplace. And this has profound implications for all stages of employment. 25% of Black women believe they have been denied a job interview because of their hair, and Black women are 54% more likely to feel like they have to wear their hair straight to a job interview to be successful.18
Once employed, the issues don’t stop there. Black women with coily/textured hair are two times as likely to experience microaggressions in the workplace than Black women with straighter hair. Worse still, over 20% of Black women 25-34 have been sent home from work because of their hair.18
But the most troubling stat was this one: almost half of Black women under age 34 feel pressured to have a headshot with straight hair.18 In other words, young Black women feel they have to put a potentially false image of themselves out in the world to get a job. Then when employed, they must constantly battle racist micro and macro aggressions to keep that job.
Some wonder why people don’t simply stop using these harmful products. These stats point to the impossible choice many Black women face: avoid toxic hair products and risk their job? Or use these products and face an increased risk of cancers of the breast, ovaries, uterus, reduced fertility, and more?
This research calls upon us to take a whole-of-society approach. We must be willing to explore our internalized, racist beliefs honestly. We must engage in intentional, empathy-based work to confront how colonial thought shows up in our lives and actively confront it. We must take a ‘nothing about us, without us’ approach and directly involve Black communities in co-creating social and cultural change.
Such change doesn’t happen quickly, and ongoing work is required. But there are positive signs on the horizon.
There are nearly 60 lawsuits underway in the U.S. against cosmetics giant L’Oreal and others. Petitioners claim that the companies knew about the dangerous chemicals in these products and their negative health impacts but continued to market and sell them anyway.19
In Canada, there are also claims underway, the first being a proposed class action lawsuit claiming hair straightening products are “are dangerous, defective and not fit for purpose.”20
The Creating a Respectful and Open World for Natural Hair Act of 2020 (CROWN Act) states that people shall not be deprived of equal rights under the law and shall not be subjected to “prohibited practices” based on their hair texture or hairstyle. The author suggests that social media, which promotes beauty culture through influencers, may offer opportunities for collective organizing and changes in beauty-related policies.21
Earlier this year, I collaborated with the ENRICH Project22 on the social media campaign The Environmental Injustice of Beauty. I was a panelist at the webinar, The Health Effects of Toxic Beauty and Personal Care Products. We received an incredibly positive response to the campaign. People were shocked to learn of the increased health risks that Black women face in using these products, the associated lax cosmetic labeling laws, and outright lies by the cosmetic industry.
If you suspect that your personal care products are harming your health, consider seeing a naturopathic doctor. Naturopathic doctors have long understood how endocrine-disrupting chemicals can affect our hormones and contribute to a wide range of health issues. NDs can help assess your body’s toxic load, determine what is contributing, and work with you to reduce toxic exposures, help toxins exit the body, and thus improve overall health.
References
1. Chang CJ, O’Brien KM, Keil AP, et al. Use of Straighteners and Other Hair Products and Incident Uterine Cancer. J Natl Cancer Inst. 2022;114(12):1636-1645. doi:10.1093/jnci/djac165
2. Brinton LA, Figueroa JD, Ansong D, et al. Skin lighteners and hair relaxers as risk factors for breast cancer: results from the Ghana breast health study. Carcinogenesis. 2018;39(4):571-579. doi:10.1093/carcin/bgy002
3. Coogan PF, Rosenberg L, Palmer JR, Cozier YC, Lenzy YM, Bertrand KA. Hair product use and breast cancer incidence in the Black Women’s Health Study. Carcinogenesis. 2021;42(7):924-930. doi:10.1093/carcin/bgab041
4. Heikkinen S, Pitkäniemi J, Sarkeala T, Malila N, Koskenvuo M. Does Hair Dye Use Increase the Risk of Breast Cancer? A Population-Based Case-Control Study of Finnish Women. PLoS One. 2015;10(8):e0135190. doi:10.1371/journal.pone.0135190
5. Llanos AA, Rabkin A, Bandera EV, et al. Hair product use and breast cancer risk among African American and White women. Carcinogenesis. 2017;38(9):883-892. doi:10.1093/carcin/bgx060
6. White AJ, Gregoire AM, Taylor KW, et al. Adolescent use of hair dyes, straighteners and perms in relation to breast cancer risk. Int J Cancer. 2021;148(9):2255-2263. doi:10.1002/ijc.33413
7. Eberle CE, Sandler DP, Taylor KW, White AJ. Hair dye and chemical straightener use and breast cancer risk in a large US population of black and white women. International Journal of Cancer. 2020;147(2):383-391. doi:10.1002/ijc.32738
8. Stavraky KM, Clarke EA, Donner A. A case-control study of hair-dye use and cancers of various sites. Br J Cancer. 1981;43(2):236-239. doi:10.1038/bjc.1981.35
9. Tzonou A, Polychronopoulou A, Hsieh CC, Rebelakos A, Karakatsani A, Trichopoulos D. Hair dyes, analgesics, tranquilizers and perineal talc application as risk factors for ovarian cancer. Int J Cancer. 1993;55(3):408-410. doi:10.1002/ijc.2910550313
10. White AJ, Sandler DP, Gaston SA, Jackson CL, O’Brien KM. Use of hair products in relation to ovarian cancer risk. Carcinogenesis. 2021;42(9):1189-1195. doi:10.1093/carcin/bgab056
11. Zhang Y, Birmann BM, Han J, et al. Personal use of permanent hair dyes and cancer risk and mortality in US women: prospective cohort study. BMJ. 2020;370:m2942. doi:10.1136/bmj.m2942
12. Why some Black women won’t or can’t quit hair relaxers – even as the dangers become clearer | Race | The Guardian. Accessed May 6, 2023. https://www.theguardian.com/world/2022/dec/12/black-women-hair-relaxers-chemicals-cancer-risk
13. To Straighten Or Not To Straighten: The Difficult Decision That Black Women Face When It Comes To Their Hair. Accessed May 6, 2023. https://www.forbes.com/sites/janicegassam/2022/10/28/to-straighten-or-not-to-straighten-the-difficult-decision-that-black-women-face-when-it-comes-to-their-hair/?sh=3054999b641f
14. Aglan MA, Mansour GN. Hair straightening products and the risk of occupational formaldehyde exposure in hairstylists. Drug Chem Toxicol. 2020;43(5):488-495. doi:10.1080/01480545.2018.1508215
15. Bilal M, Mehmood S, Iqbal HMN. The Beast of Beauty: Environmental and Health Concerns of Toxic Components in Cosmetics. Cosmetics. 2020;7(1):13. doi:10.3390/cosmetics7010013
16. James-Todd T, Connolly L, Preston EV, et al. Hormonal activity in commonly used Black hair care products: evaluating hormone disruption as a plausible contribution to health disparities. J Expo Sci Environ Epidemiol. 2021;31(3):476-486. doi:10.1038/s41370-021-00335-3
17. Raley E, Quirós-Alcalá L, Matsui EC. Chemical Exposures via Personal Care Products and the Disproportionate Asthma Burden Among the U.S. Black Population. J Allergy Clin Immunol Pract. 2021;9(9):3290-3292. doi:10.1016/j.jaip.2021.04.063
18. CROWN Act Resources. The Official CROWN Act. Accessed May 6, 2023. https://www.thecrownact.com/research-studies
19. Nearly 60 hair relaxer lawsuits against L’Oreal, others consolidated in Illinois federal court | Reuters. Accessed May 6, 2023. https://www.reuters.com/legal/nearly-60-hair-relaxer-lawsuits-against-loreal-others-consolidated-illinois-2023-02-06/
20. News · BL· C. L’Oreal targeted in proposed B.C. class action linking hair relaxers to cancer in Black women | CBC News. CBC. Published January 23, 2023. Accessed May 6, 2023. https://www.cbc.ca/news/canada/british-columbia/black-hair-class-action-lawsuit-loreal-1.6721662
21. McDonald JA, Llanos AAM, Morton T, Zota AR. The Environmental Injustice of Beauty Products: Toward Clean and Equitable Beauty. Am J Public Health. 2022;112(1):50-53. doi:10.2105/AJPH.2021.306606
22. The ENRICH Project – Exploring Toxic Legacies in Mi’kmaq and African Nova Scotian Communities. Accessed May 6, 2023. https://www.enrichproject.org/
