Then the Moderna vaccine became available to health workers in the city. She received her first Covid-19 shot about a week before her scheduled mammogram.
Quasha initially did not see much of a reaction to the vaccine, but a few days before her appointment, her left arm hurt.
Tender, swollen lumps developed under her left armpit, along with a large swelling above her collarbone – all areas where the body has lymph nodes, the body’s filters for germs.
“You have lymph nodes above and below your collarbone,” Quasha said. “You do not want to feel it. It was scary when I felt it. ‘
Lymph nodes contain immune cells that help fight invaders. That’s why it made sense to Quasha that the nodes respond to the vaccine and build antibodies as designed. But she could not be sure.
The swelling was just on the left side where she got the shot – the same side as the worrying lump. Was it a reaction to the vaccine or another sign of breast cancer?
‘It was like a wildfire’
After the ultrasound, Quasha’s radiologist was worried. She told Quasha she was looking at the lump she felt in her chest of little significance, but the lymph nodes appearing as white spots on her mammogram were a different matter.
In non-pandemic times, the finding would trigger alarm bells, which necessitated the need for further investigation, even an immediate biopsy. Yet Quasha had just had the vaccine. After Quasha discussed it with her, Quasha said that her doctor decided not to do a biopsy at that point. Instead, she told Quasha to come back in six weeks for a follow-up ultrasound.
Similar scenarios have occurred in mammograms across the country. While radiologists compared notes to colleagues, the word began to spread.
“We all started talking about it, and it was like a wildfire,” said Dr. Connie Lehman, head of breast imaging at the Radiology Department of Massachusetts, said.
“I can not tell you how many women show lumps on mammograms and people thought it would not be so common,” said Lehman, who is also a professor of radiology at Harvard Medical School.
“We wanted to advocate that women do not always have to have a biopsy,” said Dr. Lars Grimm said. Associate Professor of Radiology at Duke University School of Medicine and one of the authors of the SBI advice. “Because the standard if you see swollen lymph nodes in a patient is actually the recommendation to do a biopsy.”
Lehman of the Mass General agrees. “If you hear hoofbeats, do not think zebra,” she said. “If a woman on the same side had a vaccine in her arm and the lymph nodes were swollen, it is a normal biological reaction. It is completely expected. It simply does not make sense to start the imaging.”
That doesn’t mean women who want to be sure of their cancer status can’t have a biopsy, Grimm stressed.
“You actually have some women who want to do biopsy,” he said. “You can tell them, ‘Hey, I think it’s due to your Covid vaccine, and I’m sure it’s going to dissolve on its own in a few weeks and that you’ll be fine.” But that patient says to you, ‘I’m not going to wait comfortably, I want to know now.’ “
Focus on showing to save lives
Knowing that many women experience the same reaction to the vaccine was a welcome relief for Quasha. After a conversation with her doctor, she said she no longer needed the follow-up examination.
“I was very reassured,” Quasha said. “The point 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 planning women who missed their mammogram or are late, Lehman said.
“We have to take care of the large percentage of women who were not selected due to the downtime during Covid,” she said. ‘Just during the mass general, we could not investigate 15,000 women because of Covid, and we are still trying to get them back in.
“This is not where I should start with axillary ultrasound because someone had a vaccine and the knot swelled. It is simply not practical or pragmatic or to put the patient’s needs first,” she said.
It’s not just breast cancer, Lehman stressed. Lymph nodes in other parts of the body also respond to the Covid-19 vaccines, causing people with other types of cancer to undergo unnecessary procedures.
“There were some false alarms and some unnecessary biopsies because people did not think to ask, and they assume the node was the cancer that came back,” she said.
What to do?
To avoid unnecessary worries, 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 planning to do so soon, the association suggests that you wait at least four to six weeks after the second dose before planning your appointment.
At Mass General, Lehman and her team went a step further. They examine all women regardless of vaccine status, but tell those with no history of cancer that any swelling in the lymph nodes that can be linked to a Covid-19 vaccine is benign, which is not cancerous.
“If it is a swelling or tenderness after the vaccination in their armpit, we suggest that they wait four to six weeks, talk to their doctor, and if it persists, we should enter it to do an evaluation of it,” she said.
Whatever you do, experts emphasize, do not rush to investigate breast cancer if it is recommended. A study published Tuesday in the journal Radiology, which followed more than half a million women, made the point clear: women who skip even one scheduled mammography screening before being diagnosed with breast cancer have a significantly higher risk of to die.
The study said the risk that there would be a fatal breast cancer within ten years was 50% lower.