The side effect of the COVID vaccine may impact mammograms; cause unnecessary worry

Moderna and Pfizer COVID-19 vaccines can cause temporary enlargement of the lymph nodes under the arm near where the vaccine was given.

Accordingly, radiologists have been advised by their professional associations to consider this possibility when enlarged lymph nodes are found on mammograms of recently vaccinated women.

Enlarged lymph nodes seen on a mammogram can bring back breast cancer concerns and anxiety in the patient involved.

“I haven’t seen any cases of this to date,” said Dr. Steven R. Urbanski, who heads the radiology department at Holyoke Medical Center.

He added that the advice of organizations like the Society of Breast Imaging is important because radiologists are likely to “meet a cohort of people where you might find this” as more and more people come along. vaccinate.

“We added a question about whether you received a vaccine, a first or a second dose and on which side, to our patient admission form at the breast center, so if the radiologist performing a mammogram encounters a case. enlarged lymph nodes, this question is one of the first things they will look at. “

Urbanski says current data shows enlarged lymph nodes only occur in a small percentage of vaccinated patients and should not discourage anyone from getting vaccinated against SARS-CoV-2, the virus that causes COVID-19, or a virus that causes COVID-19. mammography.

“As someone who specializes in breast imaging, I am very attached to the annual mammogram and I feel just as strong about the COVID vaccine,” Urbanski said.

“I would be very disappointed if, nationally, we discouraged people from getting vaccinated or from delaying the vaccine because they are worried about their mammogram appointment.”

Urbanski said professional societies have alerted members to enlarged lymph nodes on mammograms of patients vaccinated against SAR-COV-2 so that they may be aware of it as a temporary side effect of vaccination in some patients.

“It won’t be the result of everyone who gets the vaccine,” Urbanski said. “It’s just to alert the breast imaging community that this is a possibility.”

He added that an enlarged lymph node after vaccination is usually a “good sign that the vaccine is working” and that “your body is responding to it”. They usually self-resolve with other side effects.

Urbanski said: “As people learn this it may ask us what should I do?”

“I’m bringing this to an individualized basis because many screening mammograms in the state and regionally have been delayed to minimize the first and second wave of coronavirus,” Urbanski said.

“A lot of people come back late. You probably won’t want to miss your mammogram if you’re already a few months late. Others who have just been vaccinated and feel comfortable delaying their mammograms for four to six weeks – and I’m only talking about asymptomatic people (those who don’t have any unwanted symptoms) – we would be happy to welcome them. . We, and I’m sure other breast imaging centers, won’t have hard rules and won’t distract people from what they should be getting. “

He added: “For the group of people who have symptoms, whether it’s a palpable lump, breast discharge or some other symptom, they should never be discouraged from breast imaging. . “

“They have a lot of anxiety,” Urbanski said. “Most of the time, fortunately, when we imagine people, things turn out well. But we’re trying to get this group of people to come as soon as possible, and there should be no delay. “

Urbanski said that “if someone had a normal, unchanged mammogram and the only differences are changes in the axillary lymph nodes, we would definitely check to see if this is consistent with the history of the COVID vaccine.”

“The next step we would do would be an ultrasound to assess the knots,” Urbanski said.

“We do this whenever we have concerns about the lymph nodes – and that gives us a full and complete assessment of the node – and then knowing the person had the COVID vaccine and if not a normal mammogram, we would definitely bring them back. anywhere. 4 to 6 to 12 weeks and reassess again and we would expect the knots to be back to normal. “

He said that one of the suggestions for breast cancer patients who receive the COVID vaccine while they are “in full swing” is to “get the vaccine done on the other side, which means that if you left the breast cancer you would have the vaccine done on your right arm, so when you come back for imaging or workup, it will not create imaging problems. “

Urbanski said that “to interpret routine screening mammograms” for a month, “we have a small group who might otherwise have normal mammograms, but who might have changes in their lymph nodes.”

“If, say, there is a change on one side only, we will treat it the same way (as those related to the COVID vaccination). We do the ultrasound – which isn’t X-rays – and then we go through a very careful clinical history with them, ”Urbanski said.

“There are a lot of things that can cause enlarged lymph nodes that are benign. Even a minor infection, insect bite, inflammation of the torso can cause enlarged lymph nodes on one side. A lot of times when I’m in the room and we do an ultrasound and review the patient’s history, I find there is an explanation for it.

He added, “In my experience, cases of lymph nodes that have been enlarged during a mammogram usually have a breast abnormality at the same time.”

Lymph nodes contain white blood cells and their enlargement, which has been observed in vaccine trials and since confirmed Through various imaging in other studies, it is believed that a temporary response to the vaccine by the body’s immune system increases these cells to counter infection.

To avoid this condition, called unilateral axillary lymphadenopathy if under an arm, in conjunction with a SARS-CoV-2 vaccination, the Society of Breast Imaging suggested, “If possible, and if this does not unduly delay care, consider scheduling screening tests before the first dose of a COVID-19 vaccination or 4-6 weeks after the second dose of a COVID-19 vaccination. COVID-19. ”

The company, whose members include of eligible radiologists certified to the board of directors, called the condition “rare occurrence” in general in women with an otherwise normal screening mammogram and any associated malignancies “highly variable”. He added that it “has been rarely reported following administration of BCG, influenza and human papillomavirus vaccines” with higher rates linked to Modern and Pfizer vaccines.

He adds: “Breast radiologists will increasingly face axillary lymphadenopathy as more patients are vaccinated, but the short- or long-term onset of mammographic lymphadenopathy after vaccination is currently. unknown. “

Dr. Jennifer Hadro, radiologist and medical co-director of Breast imaging at Baystate Health, also warned in a released statement that the company’s recommendations on when to get tested around the COVID-19 vaccination “apply only to screening mammography, that is, to women without any problems such as lump or other breast changes. “

“We know mammograms save lives, and if your doctor has ordered you to have a mammogram as a precaution after feeling a lump or other concern, it is important to stick to this appointment even if you have been vaccinated during the course. the past 4-6 weeks, ”Hadro said.

No information has yet been reported whether this condition is associated with the Johnson & Johnson vaccine, which is a single dose vaccine that does not use synthetic messenger RNA like the other two to get the body produce an immune response. He was allowed for emergency use by the United States Food and Drug Administration on February 17.

The US Task Force on Preventive Services recommends screening with mammogram once every two years for women aged 50 to 74 with an average risk of breast cancer and once every two years for women aged 40 to 49 with an average risk.

The most common side effects of COVID vaccination include pain at the injection site. Other common side effects include fatigue, fatigue, muscle pain, chills, joint pain, and fever.

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