Later, the Moderna vaccine became available to health professionals in the city. You received your first Covid-19 injection about a week before your scheduled mammogram.
Quasha didn’t notice much of a reaction to the vaccine at first, but a couple of days before her appointment, her left arm started to hurt.
Tender, swollen lumps developed under the left armpit, along with large swelling above the collarbone, all areas where the body has lymph nodes, the body’s filters for germs.
“He has lymph nodes above and below his clavicle,” Quasha said. “You don’t want to feel that. It was terrifying when I felt it.”
Lymph nodes contain immune cells that help fight invaders. That’s why made sense to Quasha that the nodes were reacting to the vaccine, building antibodies as they were designed to do. But she couldn’t be sure.
The swelling was only on the left side where he had received the injection, the same side as the concerning lump. Was it a reaction to the vaccine or another sign of breast cancer?
‘It was like a forest fire’
After the ultrasound, Quasha’s radiologist was concerned. She told Quasha that she considered the lump she had felt in her chest to be minor, but lymph nodes that showed up as white spots on her mammogram were another matter.
In non-pandemic times, that finding would sound alarms, requiring the need for further investigation, including an immediate biopsy. However, Quasha had just received the vaccine. After speaking with her, Quasha said that her doctor decided not to do a biopsy at that time. Instead, he told Quasha to come back for a follow-up ultrasound in six weeks.
Similar situations had been happening in mammography centers across the country. As the radiologists compared notes with their colleagues, the word began to spread.
“We all started talking about it, and it was like a wildfire,” said Dr. Connie Lehman, chief of breast imaging in the Massachusetts General department of radiology.
“I can’t tell you how many women show nodules on mammograms and people thought it wouldn’t be that common,” said Lehman, who is also a professor of radiology at Harvard Medical School.
“We wanted to advocate that women don’t always need a biopsy,” said Dr. Lars Grimm, Associate Professor of Radiology at Duke University School of Medicine and one of the authors of the SBI notice. “Because often the default if you see swollen lymph nodes in a patient would actually be recommending a biopsy.”
Mass General’s Lehman agreed. “When you hear hooves, don’t think of zebra,” he said. “If a woman has a vaccine on the arm on the same side and the lymph nodes are swollen, this is a normal biological response. It’s totally expected. It just doesn’t make sense to start imaging.”
That doesn’t mean that women who want to be certain about their cancer status can’t have a biopsy, Grimm stressed.
“In fact, there are some women who want to do a biopsy,” he said. “You can tell them, ‘Hey, I think this is due to your Covid vaccine, and I’m sure it will resolve on its own in a few weeks and you’ll be fine.’ But that patient tells him: ‘I’m not going to feel comfortable waiting, I want to know now.’ “
Focus on detection to save lives
For Quasha, the knowledge that many women were experiencing the same type of reaction to the vaccine was a relief from concern. After a conversation with his doctor, he said that he no longer needs the follow-up exam.
“It put me at ease,” Quasha said. “The point here is that there are a number of side effects from the vaccine that are not dangerous but can sometimes increase patient anxiety.”
Rather than taking women back for an unnecessary ultrasound, radiology centers should focus on scheduling women who have missed or delayed their mammograms, Lehman said.
“We need to address the large percentage of women who were not screened due to closures during Covid,” he said. “At Mass General alone, we were unable to screen 15,000 women due to Covid, and we are still trying to get them re-entered.
“This is not where I need to start doing axillary ultrasounds, because someone got a vaccine and the node swelled. He’s just not being practical or pragmatic or putting our patient’s needs first,” he said.
It’s not just breast cancer, Lehman emphasized. Lymph nodes in other parts of the body are also reacting to Covid-19 vaccines, causing people with other forms of cancer to undergo unnecessary procedures.
“There have been some false scares and some unnecessary biopsies because people didn’t think to ask and assume that the node was the cancer coming back,” he said.
What to do?
To avoid unnecessary worry, SBI recommends that women schedule any routine annual breast exams before receiving the Covid-19 vaccine. If a woman has already received the vaccine, or is scheduled to do so soon, the society suggests waiting at least four to six weeks after the second dose before scheduling her appointment.
At Mass General, Lehman and his team have gone one step further. They are evaluating all women regardless of vaccine status, but they tell those without a history of cancer that any swelling in the lymph nodes that may be related to the Covid-19 vaccine is benign, that is, not cancerous.
“If your concern is post-vaccination swelling or tenderness in the armpit, we suggest that you wait four to six weeks, speak with your doctor, and if it persists, we ask that you come in for an evaluation,” she said.
Whatever you do, experts stress, don’t skip breast cancer screening when it’s recommended. A study published Tuesday in the journal Radiology that followed more than half a million women made the point clear: Women who skip even a scheduled mammogram before being diagnosed with breast cancer have a significantly higher risk of dying.
In fact, the risk of having fatal breast cancer within 10 years of diagnosis was 50% lower for women who underwent regular breast screenings, according to the study.