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Vaccinations against the coronavirus can cause enlarged lymph nodes in the armpit or near the collarbone, which can be mistaken for a sign of cancer.
As vaccines are rolled out across the country, doctors are seeing more of these swollen glands in recently vaccinated people, and medical journals have started publishing reports aimed at allaying fears and helping patients to avoid unnecessary testing for a harmless disease that will go away in a few weeks.
Swelling is a normal reaction of the immune system to the vaccine and occurs on the same side as the arm where the vaccine was given. It can also occur after other vaccinations, including those against the flu and the human papillomavirus (HPV). Patients may or may not notice it. But enlarged lymph nodes show up as white spots on mammograms and chest scans, looking like pictures that can indicate the cancer has spread from a tumor in the breast or elsewhere in the body.
“I am especially keen to spread the word to all patients under surveillance after successful previous cancer treatment,” said Dr Constance D. Lehman, author of two journal articles on the problem and chief of breast imaging. at Massachusetts General Hospital. “I can’t imagine the anguish of having the CT scan and hearing, ‘We found a knot that is big. We don’t think it’s cancer, but we can’t say, “or worse,” we think it could be cancer. “”
Swelling of the armpit was a recognized side effect in large trials of Moderna and Pfizer-BioNTech vaccines. In the Moderna study, 11.6% of patients reported swelling of the lymph nodes after the first dose and 16% after the second dose. Pfizer-BioNTech appears to have a lower incidence, with 0.3% of patients reporting it. But these numbers only reflect what patients and their doctors have noticed, and radiologists say the true rate is likely higher and that many other cases are likely to show up on imaging such as mammograms, MRIs or CT scans.
The condition was not listed among the side effects reported in a Food and Drug Administration backgrounder on the Johnson & Johnson Covid vaccine. On Saturday, the agency cleared the company’s vaccine for emergency use.
Dr Lehman said it is important for imaging centers to ask patients if they have received Covid inoculations and to record the date of the shot and the arm in which it was administered.
His clinic includes this advice in a letter to patients whose screening finds swelling but no other abnormalities: “The lymph nodes in the armpit area we see on your mammogram are larger on the side where you received your recent vaccine. Covid-19. Enlarged lymph nodes are common after the Covid-19 vaccine and is your body’s normal reaction to the vaccine. However, if you feel a lump in your armpit that lasts longer than six weeks after your vaccination, you should tell your health care provider. “
According to an article by an expert panel in the journal Radiology, published Wednesday, people could avoid the problem for at least six weeks after the last dose of the vaccine.
A professional group, the Society of Breast Imaging, offers similar advice: “If possible, and when it does not unduly delay care, consider scheduling screening tests before the first dose of a Covid-19 or 4- vaccination. 6 weeks after the second dose of a Covid-19 vaccine. “
But the panel of experts also warned that non-routine imaging, needed to help cope with illness or other symptoms that may indicate cancer, should not be delayed. Vaccination either.
People with cancer are generally advised to get the coronavirus vaccine, especially because they are at a higher risk of dying from Covid than the general population. But some cancer treatments can interfere with the body’s ability to fully respond to the vaccine, and the American Cancer Society advises patients to consult their oncologists about vaccination.
In recently vaccinated people who have cancer and develop enlarged lymph nodes, more tests may be needed, including a lymph node biopsy, Dr Lehman said.
She described a patient with a newly diagnosed breast tumor who had swollen lymph nodes on the same side and who had recently been injected with Covid into her arm on that side.
A biopsy was taken, an important step to determine if there were any malignant cells in the lymph nodes that would then help decide on treatment. It was negative for cancer. The vaccine had most likely caused the swelling.
In another case, a woman who previously had cancer of the right breast had a routine mammogram that showed an enlarged lymph node in the left armpit and no other abnormalities. She had recently received a Covid vaccination in her left arm. Doctors determined that no further testing would be necessary unless the swollen nodes last longer than six weeks.
In a man with a history of bone cancer, a follow-up chest CT scan revealed swollen lymph nodes in an armpit – on the side where he had recently been inoculated with Covid. Nothing else was wrong and no further testing was necessary. The same decision was made for similar results in a recently vaccinated man who had a chest CT scan for lung cancer and in a woman with a history of melanoma.
For patients undergoing treatment for breast cancer, Dr Lehman said, the Covid injection should be given to the arm on the other side. The vaccine can also be injected into the thigh to prevent problems with swelling of the lymph nodes.
“It could really impact a lot of people if we don’t immediately start recording the status of vaccination in imaging centers,” said Dr Lehman. “I also want cancer patients to know that they can get the vaccine from the opposite side or even the leg to avoid confusion.”
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