When Shirley Billigmeier was diagnosed with breast cancer this spring, she was grateful for a good prognosis and set about preparing for the life disruption that comes with undergoing a lumpectomy, radiation and chemotherapy.
"I just had a feeling that I was just going to be sick this whole time," said Billigmeier. "And my concern was that it was just gonna absolutely take me out of my life for a while."
When her doctor told her that total hair loss was an inevitable side effect of the chemotherapy, she braced herself and bought a wig, but then a friend told her about another breast cancer patient who managed to preserve her hair using a little-known approach that involves keeping the scalp very cold during chemotherapy treatments.
Billigmeier tracked down the makers of Penguin Cold Caps, designed to help chemotherapy patients keep their hair.
"[He] gives me a list of probably 10 women," said Billigmeier. "I start calling and start having some great conversations with lots of women across the United States. And the women I was talking to, they kept their hair."
Her Minneapolis oncologist, Dr. Paul Zander, was skeptical at first. He knew that early experiments in the United States in the 1980s hadn't been very promising. Still, he gave her the OK to try it. So on each day she received chemotherapy, Billigmeier put on a freshly chilled cap chilled to -22 degrees Fahrenheit every 30 minutes for seven long hours.
Billigmeier's dream team of helpers said the undertaking ended up being a welcome distraction and a bonding experience.
"It seems silly to say that chemo was this happy day," Billigmeier's friend Nancy Marshall said. "But it was this enormously positive, upbeat thing where we all knew we were helping a dear friend. We also knew we were doing something that was potentially going to help a lot of other people. So, you know, there was a lot more riding on it than just Shirley's great hair."
But would it work? After her sixth and final treatment, Billigmeier's locks were intact.
"My hair is all there," she said. "It definitely works."
No one knows how it works. One theory is that the caps may work by decreasing blood flow to the scalp, causing the blood vessels in the scalp to shrink. This, in turn, blocks the harsh chemicals in the chemotherapy from reaching the hair follicles. But the fact is no one knows exactly why some women keep their hair after using the caps.
Some doctors are worried by the lack of data on cold caps, and they fear the treatment may even do more harm than good, for some patients. Still, cold caps are experiencing a groundswell of support from a growing number of women receiving chemotherapy who say it works -- and spread the news.
While early trials with scalp cooling showed it often was ineffective, an analysis of 53 studies showed that since 1995 research suggests the scalp cooling preserves hair in about 70 percent of patients.
But a number of doctors told ABC News they don't support the approach because of another concern.
"I don't know how well this was substantiated, but there has been concern that by blocking chemotherapy from reaching the area of the hair follicles there would be an increase in metastases of the scalp," said Dr. Mary Daly, an oncologist at the Fox Chase Cancer Center in Philadelphia.
Since there are no substantial longitudinal studies measuring such a risk, many doctors strongly discourage using the caps.