Then, the Moderna vaccine became available to health professionals in the city. She received her first Covid-19 blow about a week before her scheduled mammogram.
Quasha did not notice much of a reaction to the vaccine at first, but a few days before her appointment, her left arm began to ache.
Thin, swollen swellings developed under the left armpit, along with a large swelling above the collarbone – all areas where the body has lymph nodes, the body filters for germs.
“You have lymph nodes above and below the collarbone,” Quasha said. “You don’t want to feel them. It was scary when I felt it.”
The lymph nodes contain immune cells that help fight off invaders. Because it made sense to Quasha that the nodules reacted 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 got the blow – the same part as the worrying piece. 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 worried. He told Quasha that he thought it was the piece he had felt in his breast of little significance, but the lymph nodes that appeared as white spots on her mammogram were another problem.
In non-pandemic periods, this discovery would set off alarm bells, necessitating further investigation, even an immediate biopsy. However, Quasha had just received the vaccine. After talking to her, Quasha said her doctor decided not to do a biopsy at that time. Instead, he told Quasha to return for a follow-up ultrasound in six weeks.
Similar scenarios were occurring in mammography centers across the country. As radiologists compared notes with colleagues, it began to spread.
“We all started talking about it and it was like a fire,” said Dr. Connie Lehman, head of breast imaging in the Massachusetts Department of Radiology.
“I can’t tell you how many women have knots on mammograms and people thought it wouldn’t be so common,” said Lehman, who is also a professor of radiology at Harvard Medical School.
“We wanted to argue that women don’t always have to have 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. “Often, by default, if you see swollen lymph nodes in a patient, you would actually recommend a biopsy.”
Lehman of the table general agreed. “When you hear hooves, don’t think of the zebra,” she said. “If a woman had a vaccine in her 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 women who want to be sure about their cancer can’t do a biopsy, Grimm said.
“You actually have some women who want to have a biopsy,” he said. “You might say, ‘Hey, I think this is because of your Covid vaccine, and I’m sure it’ll work out on its own in a few weeks, and you’ll be fine.’ But that patient tells you, “I won’t be comfortable waiting, I want to know now.” “
Focus on screening to save lives
For Quasha, knowing that many women are experiencing the same type of reaction to the vaccine was a welcome relief of concern. After a discussion with her doctor, she said she no longer needed further examination.
“I was very calm,” Quasha said. The idea here is that there are a number of side effects of the vaccine that are not dangerous, but can sometimes increase the patient’s anxiety.
Instead of bringing women back for an unnecessary ultrasound, radiology centers should focus on scheduling women who have missed or expired their mammograms, Lehman said.
“We need to take care of the high percentage of women who have not been checked because of the Covid shutdowns,” she said. “At Mass General alone, we failed to examine 15,000 women because of Covid and we are still trying to bring them back.
“It’s not here that I have to start doing axillary ultrasounds, because someone had a vaccine and the lump swelled. It’s just not practical or pragmatic or it doesn’t put our patient’s needs first,” she said.
It’s not just breast cancer, Lehman said. Lymph nodes in other parts of the body also react to Covid-19 vaccines, causing people with other cancers to undergo unnecessary procedures.
“There were some fake scares and some unnecessary biopsies because people didn’t think to ask and I guess the nodule would be cancer coming back,” she said.
What to do?
To avoid unnecessary worries, the SBI recommends that women schedule any routine annual breast screening before receiving the Covid-19 vaccine. If a woman has already had the vaccine or is scheduled soon, the company suggests that you wait at least four to six weeks after the second dose before scheduling your appointment.
At Mass General, Lehman and her team took it a step further. They examine all women, regardless of vaccine status, but tell those who have no history of cancer that any swelling of the lymph nodes that could be connected to a Covid-19 vaccine is benign – meaning it is not cancerous.
“If their concern is a swelling or tenderness after the armpit vaccine, we suggest they wait four to six weeks, talk to their doctor, and if it persists, then they should come and do an evaluation of it,” she said.
No matter what you do, experts point out, don’t give up breast cancer testing when it’s recommended. A study published Tuesday in the journal Radiology, which followed more than half a million women, made it clear: Women who go through a single scheduled mammogram screening before being diagnosed with breast cancer have a significantly higher risk of dying.
In fact, the risk of having a fatal breast cancer within 10 years of diagnosis was 50% lower for women who had regular breast screenings, the study said.