Or–Should I Delay my COVID Vaccine Until After My Scheduled Mammogram?
These questions have arisen recently after reports that 10 to 15% of COVID vaccinated women have developed an enlarged lymph node in the area of the breast under the arm on the side where they received the shot. A SWOLLEN LYMPH NODE IS NOT A HARMFUL COMPLICATION OF YOUR SHOT. The TEMPORARY swelling and possible tenderness of lymph nodes is a common reaction to this and many other types of vaccines. A vaccine’s purpose is to activate the body’s immune system against an invading bacteria or virus—in this case, coronavirus—so that these defenses are ready if a real infection occurs. The lymph nodes are part of the body’s defense system. The enlarged lymph node should disappear in a few days to a few weeks. Consult your doctor if it persists or gets larger.
Unfortunately, an enlarged lymph node in the breast area can also be a warning sign of breast cancer.
A lump in this area can be a sign that cancer cells have spread to the lymph node. We have always advised women that a lump or thickening in or around the breast should be investigated promptly. Now we confront a problematic situation. This spring, millions of women have received the COVID vaccine within a very short time span. The great majority of vaccinated people are over 50. This entire group should also be receiving annual screening mammograms. Recently, radiologists began to notice a larger number of call-backs for abnormal mammogram findings that, after ultrasound examination, turned out to be a benign, swollen lymph node.
This brings us to the question that began our discussion. Should you postpone your mammogram? Some physician groups like the Society of Breast Imaging have suggested postponing your screening mammogram for 4 to 6 weeks after your vaccination. These are the radiologists who read your mammogram, but they do not care for women after a breast cancer diagnosis. Some other doctors disagree with this recommendation. The CDC and American Cancer Society recommend that you seek the advice of your own physician.
As a breast cancer survivor, I understand both sides of the issue. Receiving a call-back after your mammogram is always a bit frustrating. And, although we reassure you that most call-backs (especially in this situation) are not cancer, you cannot help but have a little anxiety. Keep in mind, extra tests are a necessary result of trying to find every cancer. They are the downside of effective breast cancer screening programs.
But is there a downside to delaying mammograms for a month or two?
The increased risk of delaying a mammogram, over the entire group of women, is statistically very small, but probably not zero. Studies suggest small but statistically significant increases in cancer deaths may result from even a short delay in finding a cancer. Delays may also increase the number of women who will need more extensive surgery or extra treatment like radiation or chemotherapy to help them survive their cancer. Physicians do want the greatest good for the largest number of people that our healthcare dollars can provide. So, delaying mammograms to reduce the number and cost of extra tests makes sense from a public health viewpoint. But risk statistics provide little comfort to an individual woman facing a breast cancer diagnosis. The “what-ifs” only make it harder. Therefore, I do not recommend that my patients postpone their scheduled mammogram. Having a bit of anxiety as you await the call-back ultrasound appointment seems like a small downside compared with the risk of delaying a serious cancer diagnosis.
If you have an upcoming mammogram scheduled in our office, our technologists will ask if you have had the vaccine, when, and in which arm. The radiologist will receive that information. If you do receive a call back, remember this was pretty common even before COVID, and most ultrasounds will detect no cancer. We are fortunate that Brookwood’s Women’s Diagnostic Center does an excellent job of scheduling the call-back appointments very quickly to minimize anxiety. You will usually hear the reassuring result that your lymph node was not a cancer before you leave the appointment.
There is NO DISAGREEMENT that women needing a diagnostic mammogram (looking for a specific problem), those with higher-than-average breast cancer risk, or those who have had or now have breast cancer should not postpone a mammogram based on vaccine status. If you have had breast cancer and will be getting the vaccine, request that it be given on the opposite side from your cancer.
The question of postponing a COVID vaccination until after an upcoming mammogram is also an easy one for me. Risk of COVID death or serious illness increases with age. Especially if you are old enough to get mammograms, and you have not yet been vaccinated, do not delay.
My best wishes for a joyful (and normal) summer thanks to this safe and effective vaccine!
Celia Stradtman MD