What Sex and the City Can Teach Us About Breast Cancer

The storyline, and why it stuck

In the later seasons of Sex and the City, Samantha Jones is diagnosed with breast cancer and goes through chemotherapy, including losing her hair. Millions of people watched it, and for many it was the first time they had seen chemotherapy portrayed at all.

The show is fiction. The treatment it depicts is not. This page uses the storyline as a doorway into what chemotherapy actually involves, and where a television version and a real one diverge.

What chemotherapy is doing

Chemotherapy targets cells that grow and divide quickly. Cancer cells qualify. So do several kinds of healthy cell, and that overlap is the whole explanation for the side effects.

NCI names the healthy cells caught in the crossfire: the cells lining the mouth and intestines, and the cells that make hair grow. Damage to those is why mouth sores, nausea and hair loss appear.

Chemotherapy is used in more than one way. It can be given before surgery or radiation to shrink a tumor, which is called neoadjuvant chemotherapy. It can be given afterward to destroy cells that may remain, called adjuvant chemotherapy. It can help other treatments work, and it can treat cancer that has returned or spread. Our overview of chemotherapy covers the drug classes in more detail.

How it is actually given

Television shows an infusion chair. That is the most common route, but not the only one.

NCI lists chemotherapy given by mouth as pills, capsules or liquids; intravenously into a vein; by injection into a muscle or under the skin; intrathecally, into the space between the layers of tissue covering the brain and spinal cord; intraperitoneally, into the abdominal cavity; intra-arterially, into the artery leading to the cancer; and topically, as a cream.

The intravenous route is the most common. It may run through a needle placed in a vein in the hand or lower arm at each session, or through a catheter or port, which is a device placed under the skin and left in for the course of treatment.

Hair loss, and what the show got right

Hair loss has a medical name: alopecia. Whether it happens depends on the drug and the dose, so NCI's advice is to ask the care team directly whether the treatment you will be receiving causes it.

NCI's practical guidance is more useful than most drama:

• Treat hair gently. Use a soft-bristle brush or wide-tooth comb. Skip hair dryers, irons, gels and clips that can irritate the scalp.
• Wash with a mild shampoo, less often, and pat dry with a soft towel.
• Some people cut their hair short first, so it is easier to deal with when it starts to fall out. Others shave it, using an electric shaver to avoid cuts.
• If you plan to buy a wig, get it while you still have your hair, so the color can be matched. Wigs can be itchy and hot; a scarf or turban is an alternative.
• Protect the scalp. Use sunscreen or a hat outdoors, and something warm indoors. Lotions and conditioners help if it itches or feels tender.

The show was right that this is emotional, not cosmetic. NCI says so plainly: many people feel angry, depressed or embarrassed about hair loss, and it helps to talk to someone who understands.

What happens afterward

This is the part a fixed number of episodes rarely covers.

After chemotherapy, hair often grows back in two to three months. It comes back very fine at first. It can be curlier, straighter or a different color than before, and it may return to how it was over time.

After radiation therapy, hair often grows back in three to six months. If the radiation dose was very high, it may grow back thinner, or not at all, in the treated area.

NCI's most common chemotherapy side effect is not the one television shows. It is fatigue: feeling exhausted and worn out. NCI's suggestions are concrete. Ask someone to drive you to and from treatment. Plan rest for the day of and the day after. Ask for help with meals and childcare for the day of treatment and at least one day after. Our page on side effects covers the wider list and how they are graded.

When to get checked

A storyline is not a screening reminder, but this is a reasonable moment for one. Contact a clinician about:

• A new lump or thickening in a breast or armpit that lasts through a menstrual cycle.
• Skin that dimples, puckers, thickens, or turns red and scaly over part of the breast.
• A nipple that turns inward, or discharge from one nipple, especially if bloody.
• A change in the size or shape of one breast.

And for anyone actually receiving chemotherapy, infection is the urgent one. NCI lists a fever of 100.5 degrees Fahrenheit — 38 °C is 100.4 °F; act at 100.4 °F —, 38 degrees Celsius, or higher as a sign of infection, along with chills, cough or sore throat, diarrhea, ear or sinus pain, a stiff or sore neck, a rash, mouth sores or white coating, swelling or redness where a catheter enters the body, and cloudy or bloody urine or pain passing it. NCI says to call the care team about signs of infection, because infections during cancer treatment can be life threatening. It also warns against taking anything for a fever, even acetaminophen or ibuprofen, without asking first, because those drugs can mask a more serious problem.

What this story does not mean

• A television arc runs to a script and an episode count. Real treatment length, intensity and outcome vary enormously by cancer type, stage and subtype.
• Not everyone having chemotherapy loses their hair. It depends on which drugs are used.
• Chemotherapy is not the only treatment for breast cancer, and it is not always part of the plan. Surgery, radiation, hormone therapy and targeted drugs all have their own place.
• One character's course predicts nothing for a real person. Our overview of breast cancer sets out the types and stages.

Sources

• https://www.cancer.gov/about-cancer/treatment/types/chemotherapy
• https://www.cancer.gov/about-cancer/treatment/side-effects/hair-loss
• https://www.cancer.gov/about-cancer/treatment/side-effects
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cancer.gov/types/breast/what-is-breast-cancer

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

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