Crown is a word that holds great meaning, particularly in Black culture, where many have adopted the word to pay homage to their hair. Throughout history, Black women have regarded their hair as a form of personal identity, cultural pride, political protest, and cultural awareness. When Black breast cancer survivors experience hair loss from cancer treatment, they must redefine their crown.

As a cancer genetics and breast health specialist, my career involves caring for those who are at high risk for breast cancer or who have had a diagnosis of breast cancer. I talk to patients extensively about surgery, genetic testing, and medical therapies. However, the tentacles of cancer reach much further. They touch the way one looks, the way one feels about themselves, and the way one gets to present themselves to the world. 

Breast cancer is the most commonly diagnosed cancer among people assigned female at birth in the U.S., and it disproportionately impacts Black communities. Although just as likely to be diagnosed with breast cancer, Black people have a 40% increased risk of dying from it compared to white people.

While chemotherapy-induced hair loss impacts all communities, Black people may be more likely to undergo chemotherapy due to more aggressive cancer subtypes (like triple-negative breast cancer) and have fewer options for resulting hair loss. Coldcapping, a technique developed to reduce hair loss in those undergoing chemotherapy by freezing hair follicles, has not demonstrated similar efficacy among Black patients compared to white. Although more recent strides have been made in creating wigs that more closely reflect Black hair texture, wigs have historically been designed to closely mimic the texture of white people’s hair, the discordance of which could make a cancer diagnosis in a Black person more apparent. Furthermore, the sociocultural impact of chemotherapy- induced hair loss has been largely understudied in Black communities, in which hair holds such profound significance.

I’ve had the privilege of interviewing the six Black breast cancer survivors featured in this photo essay. Some are Michigan Medicine patients, and some were cared for elsewhere. They talked with me about their cancer journeys through the lens of hair loss. With Black people dying at an alarming rate from breast cancer, it’s time for the medical community to take action, and that begins by listening with radical empathy to those most affected.

These survivors have redefined their own crowns. More profound than the new hairstyles they don after hair loss are the invisible crowns that they choose to wear each day: gratitude, faith, and resilience. It is my hope that their stories will empower us to act.

Meet Ann Chatman, Tanisha Kennedy, Felecia McDaniel, Shantell Elaine McCoy, Tamara Lynn Myles, and Veleria Banks.

Ann Chatman

One word to describe myself: Hopeful

Cancer journey: Ann Chatman routinely got annual mammograms until the pandemic. Like many, she stopped some of her routine care during those years. In 2023, just after her 70th birthday party, she got another mammogram and learned that she had cancer. She was in denial, but continued with surgery and chemotherapy. Her children, especially the nurse who cared for her and whom she thinks of as a daughter, were with her every step of the way. 

“You’re going to watch your mama die,” Chatman told her nurse. “That was my frame of mind,” she says. But her nurse and other children have helped her to be more positive.

Hair loss: “After the red devil [doxorubicin chemotherapy], [my hair] started falling out pretty quick. I wouldn’t even look in the mirror. It looks so bad to me. And my kids never saw me bald, you know? 

“I called [my grandson] up when I started losing my hair. I said, ‘You need to come and cut your gran’s hair.’ I was crying before then because I just did not want my hair cut. [He] was the only one that saw my bald head, of my grandchildren.

“[When I looked in the mirror,] I would just be so depressed. My sister brought me a lot of scarves. I didn’t go out of the house for a long time. I didn’t go to church until I started growing my hair back.”

Felecia McDaniel

One word to describe myself: Thankful

Cancer journey: Felecia McDaniel was at a workshop in Reno, Nevada, when she noticed a lump on her breast that was visibly protruding. Back home in Detroit, she had a breast cancer diagnosis within three weeks. 

McDaniel had aggressive, triple-negative breast cancer, with a gene mutation (RAD51D) that puts her at much greater risk of breast and ovarian cancer. She also struggled with chemo side effects. At one point, the only food she could stomach was ice cream with Vernors ginger ale.

Now, she tells her daughters, “Know your body,” so they can have self breast awareness. And she’s encouraging them to have genetic testing.

Hair loss: “After the first treatment, I went to my beauty salon and got my hair washed, blow dried, and curled. By the third treatment, it was gone. 

“My daughters and my mom, they felt better with me having the wig on. [The hair loss] bothered them more than it did me.

“I work with emotionally disturbed children. So they were happy I was back, but they of course noticed the difference. I caught a little girl looking under the back of [my wig, so] I came to school one day with a scarf on. I showed them how I looked without the wig, and they were just fascinated. They were more accepting.”

Shantell Elaine McCoy

One word to describe myself: Resilient

Cancer journey: Shantell McCoy was first diagnosed with breast cancer just six weeks after giving birth to her daughter. She had multiple surgeries, but the cancer kept coming back. She had a double mastectomy in 2013. She was diagnosed with breast cancer again in 2019 and had a second surgery. Last year, she received her third cancer diagnosis.

“I had a whole new tumor growing on top of my implant,” she says.

She had to have her breast implants removed and found out she has Li-Fraumeni syndrome, which puts her at risk of multiple cancers.

“It is something that I can pass on to my kids, and that part hurts the most.”

Hair loss: “I didn’t think I would feel that bad [about losing my hair] because I wore short hair. But it’s different. Me going to the hair shop and just telling them, ‘Okay, give me that real sharp pixie cut’ I always knew it would grow back. But to be brushing your hair and you’re just seeing gobs of hair come out — it’s emotional. It’s like, wow, this is really happening. And in that moment, you don’t really know if it’s going to come back.

“They did offer me the cold cap, but because excessive cold makes my migraines trigger, I didn’t want to add another pain on top of the pain I’m already feeling.

“I won’t try a wig because I have eczema, so I am highly sensitive to synthetic hair. I’d rather just wait till it grows back. Keep a hat on.”

Tamara Lynn Myles

One word to describe myself: Grateful

Cancer journey: In November of 2017, on her 28th wedding anniversary, Tamara Lynn Myles was recovering from a car accident. The left side of her body was already tender, and she felt something hard, like a jellybean, in her breast. It was later determined that she had ductal carcinoma. Initially, she was going to have to have a lumpectomy, chemotherapy, and radiation, but once selected for clinical trials, she had an MRI that suggested chemotherapy should come first. Her insurance company would not approve the chemotherapy, deeming it medically unnecessary. This added more stress, and she had to wait until a different insurance provider would cover it.

Hair loss: “Going through chemo, I lost my hair after the fifth week, it got so patchy. My husband shaved it, and I said, ‘I can’t walk around with my hair looking like this.’ I actually saved the hair, put it in a Ziploc bag in my Bible!

“My hairstylist said she could make me a wig, but that wasn’t me. She told me to get a baby brush and use rosemary and castor oil to massage my hair. Every morning, ritualistically, I massaged my scalp, and I brushed my head until [my hair] grew back. It grew back salt and pepper gray, and it was so straight!

“The first time I got my hair done, my girl put them tiny little curls all over my head. And I thought, ‘This is so cool. I could rock this.’ I had to change my mindset, and it’s my choice. I choose to be well. People will say ‘Wow! She lived — believing and keeping the faith. She didn’t deny herself nothing.’”

Tanisha Kennedy

One word to describe myself: Adaptable

Cancer journey: Tanisha Kennedy noticed a lump in her breast last year and called her doctor’s office. She called multiple times, but they couldn’t see her quickly enough, so she advocated for a mammogram. She received a breast cancer diagnosis, but she had already experienced a lot of loss and grief: the death of her son, the murder of her brother, and a previous abdominal cancer.

Kennedy’s cancer was triple-negative, and she struggled a lot with chemo side effects. Despite that, she remains hopeful and looks forward to spending time with her family when treatment is done.

“I want my daughters to always, always advocate for themselves,” she says. “I don’t care how many times they’re tired of you calling. Be consistent. Because if I wasn’t … I don’t know.”

Hair loss: “Going to the [hair] salon every two or three weeks — that was my thing.

“I was told [cold caps] probably wouldn’t make a difference. They said insurance didn’t pay for it, [so] if it doesn’t work, it’s like a lose-lose situation. 

“I let a young lady cut [my hair] real close on the sides, and I just had the hair up on the top. Right before I went for surgery, I had her put braids in, but I ended up cutting them myself because my scalp was so painful.

“I’m probably more comfortable not having hair [now], but then it was just like, ‘What are people going to think?’ Because I have nothing, and I feel like that’s when all the questions roll in.”

Veleria Banks

One word to describe myself: Grateful

Cancer journey: After her annual mammogram in 2021, Veleria Banks received notification that she had to go back for an ultrasound. It wasn’t the first time she’d been asked to come back, but this time was different. 

She was diagnosed with stage 1 breast cancer on her left side. She had a double mastectomy and four rounds of chemotherapy.

Hair loss: “[I couldn’t get a wig] because I have a severe allergy towards artificial hair. I knew that if I had to have chemo, that I was going to lose my hair.

“Standing there in the shower and seeing my hair come out, it was a little alarming. I called my hair stylist and said, ‘I need to come in to see you because my hair is coming out now.’ She was washing my hair; it was coming out in her bowl. I was prepared. She dried it, got her clippers out, and just went to town.

“And that’s when I had her take photographs. I was like, ‘I can do this. God gave me a nice shaped head.’ But it was winter time. Only regret I had was I did not buy a nice little knit skull cap. Once I ordered that, I was like, ‘I’m good to go.’ And I conquered every step of the way. I was good to go because I knew I was going to survive.

“God gave me some hair, and if it’s God’s will, he’ll grow it back, it’ll grow back. Look at my mane. Look at my crown.”

Versha Pleasant, M.D., MPH, is assistant professor of obstetrics and gynecology. She initiated the Redefining the Crown Project with grant funding from the U-M Institute for Research on Women and Gender. The project includes a 2023 article in Cancer, a panel discussion and photo exhibit (6 p.m., September 19, 2024, Kahn Auditorium), and a multimedia awareness campaign. The project was completed with help from research coordinator Jordyn Boggan; physician assistant Megan Williams-Morad; and Ava Purkiss, Ph.D., assistant professor of obstetrics and gynecology, of women’s and gender studies, and of American culture.