From then on, the Modern vaccine became available to health professionals in the city. She received her first Covid-19 vaccine 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 his appointment, his left arm started to hurt.
Sensitive, swollen nodules developed under the left armpit, along with a large swelling above the collarbone – all areas where the body has lymph nodes, the body’s filters for germs.
“You have lymph nodes above and below the collarbone,” said Quasha. “You don’t want to feel it. It was scary when I did.”
Lymph nodes contain immune cells that help fight invaders. And so made sense to Quasha that the nodules were reacting to the vaccine, building antibodies as they should. But she wasn’t sure.
The swelling was just on the left side, where she had taken the injection – the same side of the worrying lump. Was it a reaction to the vaccine or another sign of breast cancer?
‘It was like a fire’
After the ultrasound, Quasha’s radiologist was concerned. She told Quasha that she considered the lump she felt in her breast as of little significance, but the lymph nodes that appeared as white blisters on his mammogram were another matter.
In times of non-pandemic, this discovery would set off the alarm, requiring the need for further investigation, even an immediate biopsy. However, Quasha had just received the vaccine. After talking to her about it, Quasha said that her doctor decided not to have a biopsy at that time. Instead, she told Quasha to return for a follow-up ultrasound in six weeks.
Similar scenarios have been taking place in mammography centers across the country. As the radiologists compared the notes with colleagues, the news began to spread.
“We all started talking about it, and it was like a forest fire,” said Dr. Connie Lehman, head of breast imaging in the radiology department at Massachusetts General.
“I can’t say how many women are showing lumps 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 argue 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 statement. “Because often the pattern, if you see swollen lymph nodes in a patient, it would really be recommended to have a biopsy.”
Mass General Lehman agreed. “When you hear hooves, don’t think about zebra,” she said. “If a woman received a vaccine on the arm on the same side and the lymph nodes are swollen, this is a normal biological response. It is totally expected. It just does not make sense to start imaging.”
This does not mean that women who want to be sure about their cancer status cannot have a biopsy, said Grimm.
“You really do have some women who want to do a biopsy,” he said. “You can say to them, ‘Hey, I think this is due to your Covid vaccine and I’m sure it will resolve itself in a few weeks on its own and you will be fine.’ But that patient says to him: ‘I will not be comfortable waiting, I want to know now’. “
Focus on screening to save lives
For Quasha, knowing that many women were experiencing the same type of reaction to the vaccine was a welcome relief from the concern. After an argument with her doctor, she said she no longer needs follow-up tests.
“I was very relaxed,” said Quasha. “The point here is that there are a number of side effects of the vaccine that are not dangerous, but can sometimes increase patient anxiety.”
Rather than bringing women back for an unnecessary ultrasound, radiology centers should focus on scheduling women who have lost or are behind on their mammogram, Lehman said.
“We need to take care of the large percentage of women who were not examined because of the shutdowns during Covid,” she said. “At Mass General alone, we haven’t been able to track 15,000 women because of Covid, and we’re still trying to get them back.
“This is not where I need to start doing axillary ultrasound, because someone got a vaccine and the lump swelled up. It’s not just being practical or pragmatic or putting the patient’s needs first,” she said.
It’s not just breast cancer, said Lehman. 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 were some false scares and some unnecessary biopsies because people didn’t think to ask and they assumed the lump was the cancer coming back,” she said.
What to do?
To avoid unnecessary worries, the SBI recommends that women schedule any routine annual breast exams before receiving the Covid-19 vaccine. If a woman has already had the vaccine, or is scheduled to have it soon, society suggests waiting at least four to six weeks after the second dose before making an appointment.
At Mass General, Lehman and his team took it a step further. They are tracking all women, regardless of the status of the vaccine, but informing those without a history of cancer that any swelling in the lymph nodes that may be connected to a Covid-19 vaccine is benign – that is, not cancerous.
“If their concern is swelling or tenderness after the vaccine in their armpits, we suggest that they wait four to six weeks, talk to their doctor and, if it persists, we ask them to do an evaluation.” she said.
Whatever you do, experts emphasize, be sure to do breast cancer screening when it is recommended. A study published on 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 had regular breast exams, the study said.