Then the Moderna vaccine became available to health workers in the city. She received her first Covid-19 injection about a week before her scheduled mammogram.
Quasha didn’t notice much of a reaction to the vaccine at first, but a few days before her appointment, her left arm started to hurt.
Soft, swollen bumps developed under her left armpit, along with a large swelling above her collarbone – all areas where the body has lymph nodes, the body’s filters for germs.
“You have lymph nodes above and below your collarbone,” Quasha said. ‘You don’t want to feel it. It was scary when I felt it. ‘
Lymph nodes contain immune cells that help fight off invaders. Therefore it made sense to Quasha that the nodes responded to the vaccine and built up antibodies as intended. But she wasn’t sure.
The swelling was only on the left side where she had received the injection – the same side as the worrying lump. Was it a reaction to the vaccine or some other sign of breast cancer?
‘It was like wildfire’
After the ultrasound, Quasha’s radiologist was concerned. She told Quasha she thought it was the lump she felt in her breast of little significance, but the lymph nodes that appeared as white blobs on her mammogram were a different matter.
In non-pandemic times, that finding would ring alarm bells, requiring further investigation, even an immediate biopsy. Still, Quasha had just had the vaccine. After discussing it with her, Quasha said that at that point her doctor had decided not to do a biopsy. Instead, she told Quasha to come back for a follow-up ultrasound in six weeks.
Similar scenarios occurred in mammogram centers across the country. As radiologists compared notes to colleagues, the news began to spread.
“We all started talking about it, and it was like wildfire,” said Dr. Connie Lehman, chief of breast imaging in the Massachusetts General’s radiology department.
“I can’t tell you how many women show nodes 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 make the case 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 advisory report. “Because it is often the default setting when you see swollen lymph nodes in a patient, it is actually to recommend a biopsy.”
Lehman of the mass general agreed. “When you hear hoofbeats, don’t think about zebras,” she said. “If a woman on the same side has had a vaccine in the arm and the lymph nodes are swollen, this is a normal biological response. It’s entirely to be expected. It just doesn’t make sense to start imaging.”
That doesn’t mean women who want to be sure of their cancer status can’t get a biopsy, Grimm emphasized.
“You actually have a few women who want a biopsy,” he said. “You could tell them, ‘Hey, I think this is because of your Covid vaccine, and I’m sure it will go away on its own in a few weeks and you’ll be fine.’ But that patient says to you, “I won’t like to wait, I want to know now.”
Focus on screening to save lives
For Quasha, knowing that many women responded to the vaccine in the same way was a welcome relief. After talking to her doctor, she said she no longer needs the follow-up screening.
“I was very reassured,” said Quasha. “The point here is that there are some side effects of the vaccine that are not dangerous, but can sometimes increase anxiety in the patient.”
Rather than returning women for an unnecessary ultrasound, radiology centers should focus on scheduling women who missed their mammogram or are late, Lehman said.
“We need to take care of the large percentage of women who were not screened because of the shutdowns during Covid,” she said. “At Mass General alone, we haven’t screened 15,000 women because of Covid, and we’re still trying to get them in.
“This is not where I should be doing armpit ultrasounds because someone has had a vaccine and the node is swollen. It’s just not practical or pragmatic or puts our patient’s needs first,” she said.
It’s not just breast cancer, Lehman stressed. Lymph nodes in other parts of the body also respond to the Covid-19 vaccines, causing people with other cancers to undergo unnecessary procedures.
“There have been some false fears and unnecessary biopsies because people didn’t think to ask, and they assume the node was the cancer that came back,” she said.
What to do?
To avoid unnecessary concerns, SBI recommends that women schedule a routine annual breast screening before receiving the Covid-19 vaccine. If a woman has already had, or is soon scheduled to have, the vaccine, the association suggests waiting at least four to six weeks after the second dose before scheduling your appointment.
At Mass General, Lehman and her team have gone a step further. They screen all women regardless of vaccine status, but tell those with no history of cancer that any swelling in the lymph nodes that may be related to a Covid-19 vaccine is benign – meaning it’s not cancerous.
“If they are concerned about any swelling or tenderness in their armpit after the vaccine, we recommend that they wait four to six weeks, talk to their doctor, and if it persists, then let them come and evaluate it. ,” she said.
Whatever you do, experts insist, don’t skip getting your breast cancer screening when recommended. A study published Tuesday in the journal Radiology that followed more than half a million women made it clear: Women who skip even one scheduled mammography screening before being diagnosed with breast cancer have a significantly higher risk of dying.
In fact, the risk of fatal breast cancer within 10 years of diagnosis was 50% lower for women who had regular breast exams, the study said.