Dr. Grace Makari-Judson, associate director of Cancer Services at Baystate Health, shares insight on breast cancer patients and the COVID-19 vaccine. Dr. Makari-Judson is also the co-director of the Rays of Hope Center for Breast Cancer Research and chair of the Baystate Health Breast Network.
How do you feel about the speed at which the COVID-19 vaccine was developed?
We need to be grateful for landmark research on other viruses, such as HIV, and for the development of vaccines for SARS CoV-1 and MERS, which provided the backbone for the successful and accelerated development of the SARS CoV-2, COVID-19 vaccine. The vaccine is built on the foundation of knowledge and understanding of other RNA viruses.
Should breast cancer patients get the COVID-19 vaccine?
Yes. Breast cancer patients should get the vaccine.
We give vaccines regularly to our cancer patients. We make a distinction between different types of vaccines. Live (attenuated or weakened) vaccines such as MMR- measles/mumps/rubella are to be avoided. Vaccines that are killed and inactivated, such as the flu shot, are safe. Vaccines against subunits or parts of virus or bacteria, such as pneumococcus are also safe. We generally immunize all our new patients for the flu and often pneumococcus, at the time they start treatment.
The Pfizer and Moderna COVID-19 vaccines are subunit vaccines, made from the RNA of the virus. The J&J vaccine is made from the DNA and inserted into a harmless virus vector. Both vaccines instruct our cells to make a protein that jump starts the immune system to defend against the virus.
What about immunocompromised patients?
Immunocompromised breast cancer patients would include those who are actively receiving chemotherapy or immunotherapy for treatment. It would not include breast cancer patients who have completed active treatment and are on hormone therapy.
At this time, based on current Centers for Disease Control (CDC) guidelines, there is no reason for patients who are receiving chemotherapy and immunotherapy to avoid vaccination. Individuals can discuss with their treating physician any concerns.
Who should not receive the vaccine?
The CDC recommends that anyone with a severe allergy to mRNA vaccine components not receive the vaccine. If you have had severe allergy to other vaccines, to polysorbate, or to polyethylene glycol check with your doctor. Patients with other allergies, such as to food or medications, should not worry.
What about lymphedema risk?
There is a small risk (8-15%) of swelling at the site of the vaccine injection or under the arm, which generally resolves over a few days. Cellulitis, which is a skin infection developing at the site requiring antibiotics, is rare. We routinely give other intramuscular injections, such as the flu shot, without concern about lymphedema.
The arm opposite the side of surgery is the preferable site but concern about lymphedema should not keep an individual from receiving the vaccine.
What about mammography and timing of the vaccine?
Women may be unaware of lymph node swelling that occurs after the vaccine. Although this is harmless, it may show up on a mammogram, cause confusion about possible breast cancer and lead to additional testing. To minimize this risk, at Baystate Health, we recommend delaying your screening mammogram four to six weeks after your second vaccine dose. Of course, if a woman has a lump or other breast symptom, they should not delay any evaluation. Don’t miss an opportunity to be vaccinated but don’t skip your screening mammogram either.
What’s the bottom line?
The risk of dying from COVID-19 is now higher than the risk of death from cancer.
The more people that get the vaccine, the closer our community will get to “herd immunity” and ultimately the way out of this pandemic.
If you have further questions, please consult your physician.
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