By Dan Murphy
Should women continue to get their screening mammogram before or after they receive the COVID vaccine? And if patients have already received the vaccine, can they still go for a mammogram or other imaging?
We asked these questions to Dr. Ashley Tsang, a Breast Surgeon and Assistant Professor of Surgery, Icahn School of Medicine, at Mount Sinai Doctors- Westchester. “A lot of patients have asked me about the timing of their mammograms because they heard that the COVID vaccine can cause lymphadenopathy, or a swelling of the lymph nodes. What radiologists have seen on breast imaging, including mammogram, ultrasound, MRI and CT scans is that there can be a swelling of the lymph nodes on the same side of the body where they received the vaccine,” said Dr. Tsang.
“Other vaccinations can have this side effect, but now that everyone is getting vaccinated for COVID-19, we are seeing it more often now. If you had a COVID- 19 vaccine, and regardless of whether there is swelling or not, you should wait 4 to 6 weeks until after the 2nd dose to get your screening mammogram,” said Dr. Tsang.
Because radiologists have seen this trend, Dr. Tsang said that the Society of Breast Imaging has come up with guidelines for best timing of screening mammogram, ultrasound, MRI and PET-CT scan. “For women undergoing routine screening, the recommendation is to get the imaging prior to getting vaccinated. However, if they have already received their first dose of the vaccine, they should wait until 4 to 6 weeks after the 2nd dose before scheduling their screening mammogram,” said Dr. Tsang.
Dr. Tsang explained that imaging centers have created protocols to ask if patients have been vaccinated recently, and will correlate any imaging findings with recent vaccination. If there are findings of lymph node swelling or thickening in the arm in which a patient has received the vaccine, then patients should be followed clinically by their primary care physicians, gynecologists or breast specialists up to 6 weeks after.
Dr. Tsang said that the recommendation to delay breast imaging after recent vaccination is only in cases of screening. If patients have any breast concerns such as a mass, nipple discharge or skin changes, they should see their primary care doctor, gynecologist or breast specialist as soon as possible for diagnostic imaging. Diagnostic mammogram, ultrasound, MRI or PET/CT scan should not be delayed.
Recent statistics found that 11.6% of women who received the Moderna vaccine got tenderness and swelling after the first dose. After the 2nd dose, 16% of women experienced tenderness and swelling. More patients experienced swelling of the lymph nodes after receiving the Pfizer vaccine than the placebo group. “It is common to feel arm tenderness and swelling on the same side of the body where you received the vaccine. The swelling and tenderness can begin 2-4 days after vaccination and last as long as 10 days. If you develop these symptoms, and they persist for more than 2 weeks after vaccination, please see your primary care doctor or breast specialist.”
Overall, Dr. Tsang said that all women, regardless of diagnosis, should get the COVID vaccine. “My emphasis as a physician is to protect my patients, and while some of my patients may be scared of the COVID vaccine, there is strong evidence that the vaccine protects us from severe symptoms, hospitalization and even death. Getting the vaccine is so important, and I think that the protection from the vaccine outweighs the risk of developing swollen lymph nodes and having to delay screening mammogram for 6 weeks.”
“I don’t think that waiting to get a screening mammogram will make a significant difference for someone without breast concerns. But if you have been recently diagnosed, or have other symptoms of breast cancer like a new breast mass, nipple discharge or skin changes, I would not wait to get a diagnostic study,” said Dr. Tsang.
For all middle-aged women who have to cancel their screening mammogram because of vaccination, please remember to reschedule. Dr. Tsang has offices at Mount Sinai Doctors-Westchester in Scarsdale, 341 Central Park Avenue, (914)-370-5000. Visit https://www.mountsinai.org/locations/westchester for more information.
Ashley T. Tsang, MD is a board certified, fellowship-trained breast surgeon from Stanford School of Medicine, specializing in the treatment of benign and malignant diseases of the breast and management of patients at high risk for breast cancer. Dr. Tsang is Assistant Professor of Surgery at Icahn School of Medicine at Mount Sinai, a Diplomate of the American Board of Surgery, and a member of the Society of Surgical Oncology and the American Society of Breast Surgeons.
