COVID-19 Vaccine: What Breast Cancer Patients Should Know

In the midst of the COVID-19 pandemic, breast cancer patients are still facing their breast cancer journey and are more vulnerable than ever. NBCF is focused on being a voice for them as new information and challenges arise.

Updated: March 15, 2022

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About COVID-19
COVID-19 Vaccine
Mental Health Support

About COVID-19

What is coronavirus or COVID-19?

Coronavirus is a family of viruses. COVID-19 is a new (novel) virus in the coronavirus family that has caused the global pandemic. COVID-19 is highly infectious and can cause severe respiratory disease. It’s spread from person to person.

How can I prevent COVID-19 infection?

According to the Center for Disease Control, the best way to prevent infection is to wear a mask, stay 6 feet apart from other people, and avoid large crowds. It is also important to:

• Wash hands often with soap and water for at least 20 seconds. You can also use hand sanitizer that contains over 60% alcohol.
• Avoid people with any flu or COVID-19 symptoms – coughing, fever, loss of taste/smell, or any other flu-like symptoms.
• Clean and disinfect your surroundings, especially areas frequented or touched by other people.
• Wear an effective well-fitting mask. If available, use the higher-quality KN95 or N95 masks.

How are breast cancer patients affected by COVID-19?

According to the National Cancer Institute, breast cancer (or any type of cancer) increases your risk of severe COVID-19. Other factors may also contribute to the increased risk like obesity, heart, lung, and/or kidney disease, diabetes, pregnancy, and smoking. 

If you have been recently diagnosed with breast cancer, the important thing to remember is that you are not alone. Tens of thousands of patients across the country have successfully undergone treatment for breast cancer since the start of this pandemic. COVID-19 may have changed the landscape of our daily lives, but if you are navigating breast cancer right now, you are already a survivor.

Enter treatment with confidence that hospitals and treatment facilities know how to keep their facilities safe and clean. They know what steps you need to take to prevent COVID-19 infection if your immune system is weakened as a result of treatment. Hospitals have practiced cleanliness since before the pandemic and will continue this tradition long after.

If you are currently undergoing treatment for breast cancer, talk to your doctor about how COVID-19 infection may impact you and the best way to avoid infection. Some treatment facilities may even allow you to have virtual appointments to decrease your risk of exposure. Ask your doctor if this is an option for some of your appointments.

When you talk to your doctor, don’t hesitate to bring up your questions and fears about navigating breast cancer in the midst of COVID-19. Make a list of concerns or questions you want answered. You may have to attend your appointment alone, but it’s ok to ask your doctor if you can Facetime a friend or family member during your appointments to make sure you feel supported.  

Also, don’t be afraid or discouraged to ask for a second opinion. Getting a second opinion is standard and shouldn’t intimidate or discourage your treatment team.

I’m a breast cancer survivor and completed my treatment. Will COVID-19 affect me differently?

Currently, there is not enough known about how a prior breast cancer treatment may impact a COVID-19 infection. Certain treatments like chemotherapy do weaken the immune system, which may increase the risk of severe COVID-19 disease. However, your immune system can return to normal within a couple of months after completing chemotherapy treatments. If you are concerned about how your past breast cancer treatments may increase your risk of severe COVID-19, don’t hesitate to ask your doctor for more information. 

COVID-19 Vaccine

What should breast cancer patients and survivors do about COVID-19 vaccinations?

Everyone ages 5 years and up is now eligible for the COVID-19 vaccine. According to the National Cancer Institute, those with underlying medical conditions (this includes breast cancer) may get vaccinated for COVID-19. Breast cancer patients currently undergoing treatment may also get vaccinated now.

State and local recommendations and plans may vary, so please check your state and local resources for additional guidance. 

The Center for Disease Control (CDC) provides recommendations to federal, state, and local governments about the COVID-19 vaccine. Please visit this link for more information:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

Talk to your doctor before scheduling a vaccine to make sure you don’t have a history of severe allergic reaction to any component of the vaccine. Also, if you’re currently undergoing chemotherapy, consult your doctor about the timing. It may be important to schedule your vaccination appointment around your off-days during your treatment cycle.

Patients with a new diagnosis of breast cancer should have their COVID-19 vaccine administered in the opposite arm of where the breast cancer occurred.

For information regarding what you can do after being fully vaccinated, click here:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

What vaccines are available?

Three COVID-19 vaccines are approved for use in the United States: The Pfizer-BioNTech and Moderna are the preferred COVID-19 mRNA vaccines, and the Johnson & Johnson Janssen vaccine is still being administered in some situations.

The Pfizer-BioNTech vaccine is presently the only option for ages 5-17, while both the Moderna and Johnson & Johnson Janssen vaccines are approved for ages 18 and up. The Pfizer vaccine is given in two doses, three weeks apart, while the Moderna vaccine is delivered in two doses, four weeks apart. The primary series of the Johnson & Johnson Janssen vaccine is one dose. Recipients are considered fully vaccinated two weeks following the final dose of all three vaccines.

Those who are 12 years and up and who are moderately or severely immunocompromised should receive a total of four doses of the vaccine, a primary series of three doses of the Pfizer-BioNTech (ages 12 and up) or Moderna (18+) vaccine plus one booster. People ages 18 and up who have received the Johnson & Johnson Janssen COVID-19 vaccine should get a second dose of either the Pfizer-BioNTech or Moderna vaccine as well as a booster, for a total of three doses.

How do COVID-19 vaccines work?

The safe and effective COVID-19 vaccines help the body develop immunity to the COVID-19 virus by creating a supply of lymphocytes that remember how to fight the virus if it is identified in the future. It typically takes a few weeks to develop these lymphocytes. Vaccines significantly reduce the risk of COVID-19, including the risk of severe illness and death among those who are fully vaccinated. 

What is the booster shot and when should I get one?

While the vaccines are effective, studies reveal some declines in vaccine efficacy over time, particularly with new COVID-19 variants. Everyone ages 18 and up should receive a booster shot five months after their initial Pfizer or Moderna series or two months after their initial Johnson & Johnson Janssen series. Teens ages 12-17 should get a Pfizer booster five months following their final dose in the primary series.

The side effects of a booster dose are often similar to those of the initial series: fatigue, aches and pain, swelling at the site of injection, fever, and chills.

If I get the COVID-19 vaccine or booster, does it impact when I should get my next screening exam (mammogram)?

It depends on the type of exam. If women can safely delay a screening exam (screening mammogram or screening breast MRI) for 4-6 weeks or get their screening exam before their COVID-19 vaccine or booster shot, that is ideal.

Diagnostic imaging and exams for evaluation of a new symptom (new lump, pain, nipple discharge, a new diagnosis of breast cancer) should not be delayed.

Why do I need to delay my screening mammogram after receiving a COVID-19 vaccine?

Breast imagers have detected occasional underarm lymph node enlargement appearing on mammograms and breast MRIs as related to COVID-19 vaccine administration in the same arm that received the vaccination.

The COVID-19 vaccine triggers the immune system to be turned on, which in turn triggers the lymphatic system to turn on. This can cause the underarm lymph nodes (also known as axillary nodes) to swell and be what doctors call “reactive.” This can simulate an infection or even appear to be cancer in these nodes. To avoid confusion and recall, the timing of a routine screening mammogram should be made based on when COVID-19 vaccines were given.

The COVID-19 vaccine can cause more significant lymph node enlargement than other vaccines we have seen in the past (like the flu vaccine). Patients with enlarged underarm lymph nodes will be recalled from screening mammograms or MRIs for additional imaging like ultrasound.

In keeping with the Society of Breast Imaging guidelines, it’s recommended that recalled patients receive a follow-up exam within 4 to 12 weeks. If nodes are persistently large at follow-up, a biopsy will be advised. This should allow time for the lymph nodes to return to their normal size.

I am concerned about delaying my screening mammogram after receiving the COVID-19 vaccine. What can I do?

Patients should feel comfortable discussing any concerns with their healthcare team, whether that’s a primary doctor or a nurse. If not prompted, it’s recommended that the patient share whether she has had a COVID-19 vaccine, date, and which arm, so her healthcare team can record the details.

What are the COVID-19 variants?

You may have heard of COVID-19 variants such as Delta or Omicron. As viruses evolve, mutations can occur, resulting in new forms or variants. Variants are expected to occur and the CDC continues to monitor the reporting and spread of any new variants.

Vaccination reduces your risk of severe illness, hospitalization, and/or death from any COVID-19 variant. Staying up-to-date on your vaccines and boosters, wearing a mask in public, and maintaining appropriate distance can help you further protect yourself and slow the spread of any new variants.

What are the side effects of the COVID-19 vaccine?

Side effects of the vaccine will vary for each individual, and they may include pain at the injection site, headache, muscle, and joint pain, or chills and fever. Consult your doctor if you have concerns about potential side effects you may experience. Other information on the vaccine can be found at: https://www.cvs.com/immunizations/covid-19-vaccine

How can I stay safe as an immunocompromised patient while the pandemic continues?

First, stay up-to-date on your vaccinations and boosters as needed. It is also recommended to wear a high-quality, well-fitting mask or respirator in public places with medium to high COVID-19 levels. When possible, avoid crowds and poorly ventilated spaces.

Regular testing can also help you stay safe and prevent the spread to others. Free tests are available from the U.S. government at https://www.covidtests.gov/ and over-the-counter tests are more readily available at pharmacies across the country.

If you test positive for COVID-19 as a breast cancer patient, treatment may be available. Contact your physician immediately after a positive test to determine your eligibility, even if your symptoms are mild. 

Finally, continue to monitor your health daily, maintain social distance, and wash your hands often.

Mental Health Support

I’m undergoing treatment for breast cancer during the COVID-19 pandemic. I feel isolated. Is there any help?  

Yes. Since the beginning of the pandemic, we have heard from countless breast cancer patients. One common feeling has emerged – isolation. If you are feeling isolated right now, you are not alone. We are here to offer help and hope.

Going through the process of breast cancer – screening, diagnosis, surgery, treatment – without a spouse, family member, or friend is really difficult. In normal times, patients can bring someone to their appointments as support. Because of COVID-19 restrictions, many hospitals may only allow patients to attend appointments.  

It’s important to recognize this feeling – I’m feeling alone or isolated – and to communicate this to your friends and loved ones. If you don’t feel supported or if you want additional help, it’s ok to reach outside your circle.

Here are a few ideas that may help: 

• Talk to your doctor or patient navigator about your feelings. Your doctor may not be able to spend much time with you, but should be able to address these feelings and offer advice on where you can get additional help. Also, your patient navigator is trained to help you access mental health and cancer support services. Navigators are trained to listen and overcome any obstacle you face during breast cancer treatment.

• Talk to a psychologist, counselor, social worker, or clergy. You may need to reach out to a counselor or psychologist for additional help processing the emotions of your diagnosis, treatment, and survivorship. Your insurance may even cover this service. If not, many nonprofits have counselors and social workers on staff to help you navigate your mental health for free. Also, some counselors offer payment options on a sliding scale based on your income, so don’t be intimidated to ask for help if you feel like you can’t afford it.

• Join a support group. NBCF offers a virtual support group for patients diagnosed with breast cancer. Organizations like Cancer Support Community  also offer support groups and mental health support through cancer. Talking to other patients going through breast cancer can be immensely helpful, because they understand how you feel.

• Join an online (Facebook) or virtual (Zoom) group of other breast cancer patients and survivors. Online communities have supported many breast cancer patients during the pandemic. Social networks like Facebook have groups dedicated to breast cancer patients and survivors. Some of the groups are large (10K+ users) and you can find an instant connection with other survivors. Others are smaller (under 100 users) and you may find a deeper connection with just a few other patients. You can even start a group yourself and invite your close friends, family, or other survivors you may know.

• Register for a free HOPE Kit. A few years ago, we asked over 1,500 breast cancer patients to tell us what items were most useful to them during their treatment. We took their answers and created the HOPE Kit – a tangible expression of hope, providing comfort and encouragement to women undergoing breast cancer treatment. HOPE Kits are filled with thoughtful items that help during treatment like fuzzy socks, water tumblers, tea, hypoallergenic cosmetics, unscented lotion, lip balm, a journal, educational resources, and inspiring notes from other patients and supporters. When patients receive one of our HOPE Kits, they tell us that they don’t feel as isolated and that they now feel connected to something larger than their individual journey. For more information about how to get a HOPE Kit, visit: https://www.nationalbreastcancer.org/breast-cancer-support/hope-kit.

• Learn how to practice mindfulness. The stress of a breast cancer diagnosis and treatment can wreak havoc on the body. The stress of the pandemic and quarantine adds another layer. One way that research has proven to reduce stress and improve your quality of life is the practice of mindfulness. The National Cancer Institute defines mindfulness as the concept of being mindful or having increased awareness of the present. Mindfulness uses breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress. One of the great things about the improvement of technology in recent years is the launch of mindfulness apps that can be downloaded on your phone and used wherever you are.

While COVID-19 has changed how we interact with one another, no one should face breast cancer alone. If you need additional help, please contact our team: [email protected].