Connecticut Post

Docs: Make time between COVID vaccine, mammogram

- By Ed Stannard edward.stannard@hearst mediact.com; 203-680-9382

According to the Centers for Disease Control and Prevention, there was a greater chance of swollen lymph nodes after the second dose of the Moderna vaccines than after the first, with 16 percent of women under age 65 and 8.4 percent of those 65 and older reporting enlarged nodes. The CDC did not report the rate of swollen lymph nodes after the Pfizer-BioNTech vaccine.

Some women who have receive the COVID-19 vaccine and then go for their annual mammogram may get a scare when the X-ray shows a swollen lymph gland, doctors say.

So doctors have recommende­d women have mammograms prior to getting the vaccine, or to space out the two procedures by four to six weeks. And women should be sure to speak to their own physician about timing and let them know they’ve been vaccinated and on which arm they received the shot, because that is the arm under which the swollen lymph gland is likely to show, doctors say.

While breast cancer can create a similar image, chances are high that the lump under the armpit is not malignant, but is a side effect of the vaccine, say physicians who specialize in breast imaging.

“Rarely can a patient have an enlarged lymph node due to an occult breast cancer” (which otherwise is undetected), said Dr. Regina Hooley, interim division chief of breast imaging at Smilow Cancer Hospital.

Any vaccine can cause the reaction, she said.

“Now that people are getting the [COVID-19] vaccine, we are seeing more enlarged lymph nodes in the axilla,” the area under the arm that often is included in the mammogram, she said. Some are large enough for the patient to feel, she said.

Hooley said 10 percent to 15 percent of women will have an enlarged lymph node “typically on the side they got the vaccine,” Hooley said. “It’s not because of cancer. That is the body’s normal immune response.”

According to the Centers for Disease Control and

Prevention, there was a greater chance of swollen lymph nodes after the second dose of the Moderna vaccines than after the first, with 16 percent of women under age 65 and 8.4 percent of those 65 and older reporting enlarged nodes. The CDC did not report the rate of swollen lymph nodes after the Pfizer-BioNTech vaccine.

According to recommenda­tions by the Society for Breast Imaging, swollen lymph nodes in the armpit have been “rarely reported following the administra­tion of [bacille CalmetteGu­érin], influenza and human papilloma vaccinatio­ns. However, higher rates of axillary adenopathy have been reported with administra­tion of both COVID-19 vaccines … Moderna and Pfizer-BioNTech.”

Such swelling is found in just 0.02 percent to 0.04 percent of mammograms overall, the society reported.

“Of course, the first week this happened, we didn’t know” it was the vaccine causing the swelling, Hooley said. “Once we started noticing it, we put it in place that our techs would ask” whether the patient had recently been vaccinated.

When cases began showing up in January, “initially we were calling back the patients. It didn’t take us long to realize that it was COVID vaccine-related,” she said. “With a flu vaccine it happens but it’s not common.”

If a woman whose mammogram shows an enlarged lymph node has been vaccinated recently, she will be called back in a few weeks to see whether the swelling has reduced. “Initially, we were recalling our patients for ultrasound when we saw this on the mammogram, but now are generally

calling it within normal limits … because we’re seeing it so frequently,” Hooley said.

The exception is if the woman has dense breast tissue. In that case, a screening ultrasound will be ordered, she said.

Dr. Jessica Leung, president of the Society of Breast Imaging, said the increased number of enlarged lymph nodes showing up on mammograms is “a relatively new event. We don’t have a national registry for these matters, so it’s really anecdotal case reports that we have. … In an average practice, you’ll probably see one case a week.”

There are other reasons lymph nodes can become swollen, Leung said. Even nicking the skin while shaving under the arm can cause the immune system to activate.

While other vaccines can

cause the same issue, “it’s all about a numbers game,” Leung said. Other vaccines have not been given “in nearly as many people in such a short time, and anything COVID, you’re going to get attention.”

What raises women’s anxiety is the fact that breast cancer usually spreads through the lymphatic system.

Leung said it’s best if it’s possible to schedule a mammogram either before receiving the COVID vaccine, or four to six weeks afterward. “Obviously, for most of us, you cannot control the timing of the vaccine,” she said.

“If you had a vaccine … and the timing works, chances are it’s the COVID vaccine and not a cancer,” she said.

 ?? Yale University / Contribute­d ?? Dr. Regina Hooley
Yale University / Contribute­d Dr. Regina Hooley
 ?? Contribute­d Photo ?? Dr. Jessica Leung
Contribute­d Photo Dr. Jessica Leung

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