The New York TimesMar 03, 2021 09:54:08 IST
Coronavirus vaccines can cause enlarged lymph nodes in or near the armpit, which can be mistaken for a cancer sign. As vaccines are rolled out across the country, doctors are seeing more and more of these swollen nodes in people who have recently received the vaccine, and medical journals have begun publishing reports aimed at has been reducing fear and helping patients avoid unnecessary tests for a harmless condition that lasted a few weeks. Inflammation is a normal immune system response to the vaccine, and occurs on the same side of the arm where the bullet was administered. It can also occur after other vaccines, including those for influenza and human papillomavirus (HPV). Patients may or may not notice it.
But the enlarged lymph nodes appear as white blobs on mammograms and breast scans, similar to images that can indicate the spread of cancer from a tumor in the breast or elsewhere in the body.
“I especially want to extend the word to all patients who are being screened after previous successful cancer treatment,” said Dr. Constance D. Lehman, author of two journal articles on the problem and head chest images at Massachusetts General Hospital. “I can’t think of the worry of getting the scan and hearing, ‘We found a node that’s big. We don’t think it’s cancer but we can’t say, ‘or worse,’ We think it ‘s probably cancer. ‘”
The swelling in the armpit was a known side effect in major Moderna and Pfizer-BioNTech vaccine trials. In the Moderna study, 11.6% of patients reported swollen lymph nodes after the first dose, and 16% after the second dose. Pfizer-BioNTech appeared to have a lower frequency, 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 seems to be higher, and that many more cases are likely to appear. on images such as mammograms, or MRI or CT scans.
The condition was not listed among the side effects reported in a preparatory document from the Food and Drug Administration regarding the Johnson & Johnson COVID vaccine. On Saturday, the group approved the company’s vaccine for emergency use.
Lehman said it was important for imaging centers to ask patients if they had received COVID inoculations and record the date of the imaging and the arm in which it was given.
Her clinic incorporates this advice in a letter to patients whose screens look for swelling but no other anomalies: “The lymph nodes in your armpit area are visible us on your larger mammogram on the side where you recently had the COVID-19 vaccine. Enlarged lymph nodes are common after the COVID-19 vaccine and are the body’s normal response to the vaccine. However, if you feel a lump of your lump that lasts more than six weeks after your vaccination, you should tell your healthcare provider. “
One way people could avoid the problem is to delay routine mammograms and other imaging for at least six weeks after the last dose of the vaccine, according to an article by a panel of experts in the journal Radiology , published Wednesday.
A professional body, the Breast Imaging Association, offers similar advice: “If possible, and when it does not delay care, consider scheduling tests before the first dose of COVID-19 vaccine or 4-6 weeks after the second dose of the COVID-19 vaccine. ”
But the panel of experts also warned that nonroutine imaging, which is needed to help treat illness or other symptoms that may indicate cancer, should not be delayed. Vaccines should not be given.
People with cancer are generally advised to have the coronavirus vaccine, especially as they are at greater risk of dying from COVID than the general population. But some cancer treatments may hinder the body ‘s ability to fully respond to the vaccine, and the American Cancer Society advises patients to consult their oncologists about vaccinations.
In recently vaccinated people who have cancer and develop enlarged lymph nodes, more tests may be needed, including a biopsy of the nodes, Lehman said.
She described one patient with a newly diagnosed breast tumor who had swollen lymph nodes on one side, and recently received a COVID bullet in the arm on that side.
A biopsy was performed, an important step to determine if there were malignant cells in the nodes that would help determine the course of treatment. He was negative for cancer. The swelling is probably caused by the vaccine.
In another case, a woman who had a previous breast cancer had a routine mammogram that showed an enlarged lymph node in her left armpit, and no other neuralgia. She recently received the COVID vaccine in her left arm. Doctors decided that further tests would not be needed if the swollen nodes did not last more than six weeks.
In a person with a history of bone cancer, a breast CT scan was performed as part of a follow-up of swollen lymph nodes in one armpit – on the side where he had recently been exposed to COVID. There was nothing else wrong and no further tests were needed. The same decision was made for similar decisions of a recently vaccinated man who had a breast CT for screening for lung cancer, and in a woman with a history of melanoma.
For patients receiving treatment for cancer in one breast, Lehman said, the COVID pill should be given in the arm on the other side. The vaccine can also be injected into the thigh to prevent any issues with inflammation in the lymph node.
“This could have a huge impact on many people if we don’t start recording vaccine status immediately at imaging centers,” said Lehman. “I also want cancer patients to know that they can get the vaccine on the other side or even the leg to avoid upset.”
Denise Grady. c.2021 New York Times Company