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Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana

Journal of Exposure Science & Environmental Epidemiology volume 33, pages 301–310 (2023)Cite this article

A Correction to this article was published on 29 January 2022

This article has been updated

Abstract

Background

Hair relaxers and skin lighteners have been commonly used by African women, with suggestions that they may have hormonal activity.

Objectives

To investigate the relationship of hair relaxer and skin lightener use to serum estrogen/estrogen metabolite levels.

Methods

We utilized the postmenopausal population-based controls of the Ghana Breast Health Study to estimate adjusted geometric means (GM) and 95% confidence intervals of individual circulating estrogen levels by hair relaxer/skin lightener exposure categories.

Results

Of the 585 postmenopausal women included in our analysis, 80.2% reported hair relaxer use and 29.4% skin lightener use. Ever hair relaxer use was positively associated with estriol (adjusted GM 95.4 pmol/L vs. never 74.5, p value = 0.02) and 16-epiestriol (20.4 vs. 16.8, p value = 0.05) particularly among users of lye-based hair relaxers. Positive associations between scalp burns and unconjugated estrogens were observed (e.g., unconjugated estrone: 5+ scalp burns 76.9 [59.6–99.2] vs. no burns 64.0 [53.7–76.3], p-trend = 0.03). No association was observed between use of skin lighteners and circulating estrogens.

Significance

This study presents evidence that circulating 16-pathway estrogens (i.e., estriol and 16-epiestriol) may be increased in users of lye-based hair relaxer products. Among hair relaxer users, unconjugated estrogen levels were elevated in women with a greater number of scalp burns.

Impact statement

In this population-based study of hair relaxer and skin lightener use among postmenopausal women in Ghana, altered estrogen metabolism was observed with hair relaxer use, particularly among women using lye-based products or with a greater number of scalp burns. In contrast, skin lightener use was not associated with differences in estrogen metabolism in this population. Continued investigation of the potential biological impact on breast cancer risk of hair relaxer use is warranted.

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Fig. 1: Geometric means of the most abundant estrogen from each pathway by hair relaxer use exposure category.

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Data availability

The datasets generated or analyzed for the current study are not publicly available due to data privacy of patients but are available from the corresponding author upon reasonable request.

Change history

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Acknowledgements

The success of this investigation would not have been possible without exceptional teamwork and the diligence of the field staff who oversaw the recruitment, interviews and collection of data from study subjects. Special thanks are due to the following individuals: Korle Bu Teaching Hospital,Accra—Dr. Adu-Aryee, Obed Ekpedzor, Angela Kenu, Victoria Okyne, Naomi Oyoe Ohene Oti, Evelyn Tay; Komfo Anoyke Teaching Hospital, Kumasi— Marion Alcpaloo, Bernard Arhin, Emmanuel Asiamah, Isaac Boakye, Samuel Ka-chungu and; Peace and Love Hospital, Kumasi—Samuel Amanama, Emma Abaidoo, Prince Agyapong, Thomas Agyei-Ansong, Debora Boateng, Margaret Frempong, Bridget Nortey Mensah, Richard Opoku, and Kofi Owusu Gyimah. The study was further enhanced by surgical expertise provided by Dr. Lisa Newman of the University of Michigan and by pathological expertise provided by Drs. Stephen Hewitt and Petra Lenz of the National Cancer Institute, and Dr. Maire A. Duggan from the Cumming School of Medicine, University of Calgary, Canada. Study management assistance was received from Ricardo Diaz, Shelley Niwa, Usha Singh, Ann Truelove and Michelle Brotzman at Westat, Inc. Appreciation is also expressed to the many women who agreed to participate in the study and to provide information and biospecimens in hopes of preventing and improving outcomes of breast cancer in Ghana.

Funding

This research was supported in part by funds from the intramural research program of the National Cancer Institute, National Institutes of Health.

Author information

Author notes

  1. These authors contributed equally: Louise A. Brinton, Britton Trabert.

Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Ashley M. Geczik, Roni T. Falk, Thomas U. Ahearn, Montserrat Garcia-Closas, Louise A. Brinton & Britton Trabert

  2. Protein Characterization Laboratory, Leidos-Frederick, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA

    Xia Xu

  3. Peace and Love Hospital, Kumasi, Ghana

    Beatrice Wiafe-Addai

  4. Korle Bu Teaching Hospital, Accra, Ghana

    Joel Yarney, Verna Vanderpuye, Florence Dedey, Lawrence Edusei & Joe-Nat Clegg-Lamptey

  5. Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Baffour Awuah, Ernest Adjei, Francis Aitpillah, Ernest Osei-Bonsu, Joseph Oppong & Nicholas Titiloye

  6. University of Ghana, Accra, Ghana

    Richard Biritwum & Kofi Nyarko

  7. Loma Linda University, School of Public Health, Loma Linda, CA, USA

    Seth Wiafe

  8. Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Daniel Ansong

  9. The University of Edinburgh, Cancer Research UK Edinburgh Center, Edinburgh, UK

    Jonine Figueroa

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  1. Ashley M. Geczik
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Contributions

AMG: statistical analysis, data interpretation, writing, and critical review of the manuscript. BT: study conception, study design, statistical analysis, interpretation of results, writing, and critical review of the manuscript. LAB: study conception, study design, data acquisition, data interpretation, writing, and critical review of the manuscript. XX: laboratory analysis and critical review of the manuscript. JF: study design, data acquisition, and critical review of the manuscript. TUA, MGC: data/study management and critical review of the manuscript. RTK, DA, JY, BWA, LE, FD, VV, NT, EA, FA, EOB, JO, RB, KN, SW, BA, JNCL: data acquisition and critical review of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Britton Trabert.

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The authors declare no competing interests.

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All questionnaires were administered after obtaining written informed consent on forms approved by institutional review boards in the U.S. and Ghana.

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The original online version of this article was revised: In the original article the affiliation details for the authors Thomas U. Ahearn, Montserrat Garcia-Closas, Louise A. Brinton, and Britton Trabert were incorrectly assigned to affiliation "2" instead of "1".

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Geczik, A.M., Falk, R.T., Xu, X. et al. Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana. J Expo Sci Environ Epidemiol 33, 301–310 (2023). https://doi.org/10.1038/s41370-021-00407-4

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