Breast cancer Chemotherapy Quality of life Scalp coolingBackground: Chemotherapy-induced alopecia could cause significant psychological changes, affecting patients' quality of life and their capacity to cope with the disease. Objectives:The aims of this study was to analyze the effectiveness of scalp cooling (SC) to prevent chemotherapy-induced alopecia in patients with breast cancer and to compare the use of automated versus nonautomated therapy delivery devices. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Scopus, Web of Science, and ClinicalTrials.gov from their inception to October 2022. A meta-analysis was performed to assess the effects of SC to prevent chemotherapy-induced alopecia in patients with breast cancer using fixed-effects models to calculate the pooled relative risk (RR) and corresponding 95% confidence interval (CI). Results:The 8 included studies showed a 43% reduction in the risk of chemotherapy-induced alopecia (RR, 0.57; 95% CI, 0.50-0.64) after the use of SC.Moreover, the use of automated SC devices showed a 47% reduction (RR, 0.53; 95% CI, 0.45-0.60) in the risk of chemotherapy-induced alopecia versus a 43% reduction in the risk of chemotherapy-induced alopecia for nonautomated SC devices (RR, 0.57; 95% CI, 0.44-0.70). Conclusion: Our results showed that SC significantly reduced the risk of