Story at a glance
- The Society of Breast Imaging recently updated their mammogram recommendations for women who receive the COVID-19 vaccine.
- Axillary adenopathy in women is rare (reported in .02%-.04% of screening mammograms), but when present it can be an indication of breast cancer.
- 11.6% of patients who received the Moderna COVID-19 vaccine experienced axillary adenopathy after the first dose, 16.0% of patients experienced it after the second.
- This side effect of receiving the vaccine mimics breast cancer symptoms.
New recommendations for mammograms
The Society of Breast Imaging (SBI) released a statement which updates their mammogram recommendations. The statement specifically addresses the topic of an observed side effect of receiving the COVID-19 vaccination.
This statement follows the observation from radiologists across the country who say that they’ve noticed an increased amount of swollen lymph nodes in women’s mammograms following a recent COVID-19 vaccination.
While axillary adenopathy (swollen lymph nodes in the armpit/breast region) are typically rare (reported in .02%-.04% of screening mammograms)(1), out of those who received the vaccination the percentage is much higher (11.6% after the first dose, 16.0% after the second)(2).
The SBI now recommends to “consider scheduling screening exams prior to the first dose of a COVID-19 vaccination or 4-6 weeks following the second dose of a COVID-19 vaccination.”(3)
Breast Imaging Reporting and Data System
If the mammogram reveals a swollen lymph node, it automatically requires further testing. This is due to the Breast Imaging Reporting and Data System (BIRADS).
BI-RADS is defined as “a scheme for putting the findings from mammogram screening (for breast cancer diagnosis) into a small number of well-defined categories.”(4)
The released statement from the SBI says that “Current recommendations from the 5th edition of the BI-RADS Atlas state that, “In the absence of a known infectious or inflammatory cause, isolated unilateral axillary adenopathy [on screen mammography] should receive a category 0.””
A BI-RAD category 0 means that “the assessment is not complete and breast cancer specialists may recommend additional work-up. So, further work-up may include spot compression, magnification, or breast ultrasound.”(5)
Additional costs and worry
Brett Parkinson, MD, medical director of Intermountain Healthcare’s Breast Care Center in Murray, Utah, explained the logic behind changing the mammography recommendations.
He said, “We have procedures in place to confirm if swollen lymph nodes are actually cancer, but we don’t want to have a patient go through the undue stress and anxiety of follow up visits, if they don’t have to.”(6)
When he says ‘procedures’ he is referring to the BIRADS. Since the finding of a swollen lymph node is automatically a BIRADS category 0, it requires additional observation to be considered a complete test.
The period of time between the initial mammogram and additional testing causes a rise in anxiety for the patients. Not only this, but it will cost more than if they only needed one test.
Common doesn’t mean normal
Dr. Parkinson said, “We’ve seen this type of swelling on scans before, but never so pronounced because of one type of vaccine,”(7)
Axillary adenopathy seems to be a common side effect of receiving the vaccine. However, this doesn’t necessarily mean that it’s normal. Dr. Parkinson said himself that this has never been observed from a single vaccine before.
There is no study to observe the long-term effects of swollen lymph nodes to this degree, yet. The SBI recommends waiting 4-12 weeks after receiving the second dose of a COVID-19 vaccination because it takes approximately that long for the swelling to go down.
The statement from the SBI also mentions that, “If axillary adenopathy persists after short term follow up, then consider lymph node sampling to exclude breast and non-breast malignancy.” (8)
This could mean that there is a slight chance that the swelling takes longer to go down or might never go down which would signal a larger underlying issue.
Since there no real study observing the COVID-19 vaccination’s role in axillary adenopathy and its long-term effects, people’s approach to this vaccination should be with caution.
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(1-3, 8) Society of Breast Imaging.“SBI Recommendations for the Management of Axillary Adenopathy in Patients with Recent COVID-19 Vaccination”. 2021.
(4-5) Halls, Steven, MD. “BIRADS”. May 7, 2019. Retrieved from https://breast-cancer.ca/bi-rads/.
(6-7) Intermountain Healthcare. “Intermountain Healthcare Adopts New Mammography Guidelines That Women Be Screened Prior to COVID Vaccine or Delay Until Four Weeks After Final Dose”. February 9, 2021. Retrieved from https://intermountainhealthcare.org/news/2021/02/intermountain-healthcare-changing-mammogram-guidelines-for-women-due-to-covid-vaccine/.