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COVID-19 and Breast Cancer: What Patients Need to Know

By BCRF | November 8, 2022

Answers to common questions about navigating COVID-19 and breast cancer, COVID vaccines and mammograms, and more

During the COVID-19 pandemic, people with breast cancer, survivors, and loved ones have dealt—and are still dealing with—fear and uncertainty about staying safe, especially while undergoing treatment.

The best advice for navigating breast cancer now is to talk to your doctor about your individual situation. Below you will find expert guidance on some common questions and concerns.

This page has been updated.

How can I protect myself from COVID-19?

The approved vaccines and booster shots help prevent severe illness and death from COVID-19, and they reduce both your risk of getting the disease or spreading it. New treatments, like the antivirals Paxlovid and Remdesivir, offer options to help prevent severe illness and death after infection. For people who are severely immunocompromised—including those with cancer—the FDA has also approved a preventative medication called Evusheld.

To help protect yourself from COVID-19—and especially from current and future variants—on a day-to-day basis, play it safe and wear a mask when you’re in indoor public spaces if you are in an area with medium or high transmission rates (use the CDC’s map here). Review the CDC’s guidelines for mask fit, filtration, and layering to ensure you are maximizing your mask’s protection. Wash your hands frequently and try to maintain distance from others in public spaces.

How do the COVID-19 vaccines work?

The vaccines for COVID-19, like those for influenza and other infectious diseases, all work by introducing your body to a foreign pathogen (or part/piece of one) to kick your immune system into action. As your immune system fights back, it develops T and B cells to “remember” how to do so again in the future. This means that you can develop immunity against COVID-19 without being exposed to it. You can read more about how each of the approved vaccines—from Pfizer/BioNTech, Moderna, Novavax, and Johnson & Johnson/Janssen—here.

All of the approved COVID-19 vaccines and boosters have been found to be safe and effective in real world studies.

Who should get the COVID-19 vaccine and boosters?

The CDC now recommends that everyone six months of age and older be vaccinated against COVID-19. At minimum this includes what’s known as the initial “primary series doses” plus boosters, depending on age and previous boosters.

Children six months old to four years old should only complete their primary series doses. People five years and older should get boosters in addition to primary doses. The CDC recommends children between the ages of 5-11 get the original booster and people 12 and older get one updated Pfizer or Moderna booster.

People who have had COVID-19 should also get boosters for added protection. Those who are immunocompromised have different guidelines here and may also be eligible for the preventative treatment, Evusheld.

Find more guidelines and age-based recommendations here.

Can you still get COVID-19 even if you are vaccinated​?

No vaccine is 100 percent effective, so it is possible to contract COVID-19 while vaccinated. These are called vaccine breakthrough cases, and they have been especially common with the Omicron variants. The good news is that if you’re infected after vaccination and boosting, research has shown that you’re still protected against severe illness and death.

Are vaccines as effective for breast cancer patients​?

Cancer treatments such as chemotherapy and radiation suppress the body’s immune system. Because of that, the CDC has warned that the vaccines may not offer full protection to immunocompromised people, making them particularly vulnerable to breakthrough infections. Still, some protection is better than nothing. Find the CDC’s guidelines for people who are moderately to severely immunocompromised here.

Talk to your healthcare team about your options. And because cancer patients may be at an increased risk of breakthrough infections, your caregivers, family, and friends should consider vaccination to protect you.

Why do people need vaccine booster shots if the vaccines are effective?

While the approved vaccines are incredibly effective at preventing severe illness, hospitalization, and death—even against highly transmissible variants—research has shown that the vaccines may lose some protection over time. This is not a sign that the vaccines don’t work.

Research is ongoing on booster shots, but studies so far have shown they enhance protection.

Should breast cancer patients receive booster shots of the vaccine​?

If you are receiving treatments that make you immunocompromised, the CDC recommends you consider additional boosters in conversation with your healthcare provider. These recommendations vary according to what vaccine you’ve had.

Some patients and others who are immunocompromised may also be eligible for preventative Evusheld injections, in addition to vaccination and boosting.

Is the COVID-19 vaccine safe for breast cancer patients?

Early information indicates that the leading vaccines are safe for cancer patients. The leading COVID-19 vaccines do not use live viruses that can cause serious side effects for patients undergoing immunosuppressive treatments. The CDC has outlined how each of the major types of vaccines (mRNA, vector, and protein subunit) work here.

RELATED: COVID-19 and Breast Cancer: BCRF’s Resources for Patients During the Coronavirus Crisis

Should I delay my mammogram because a COVID-19 vaccine side effect could cause swollen lymph nodes under my armpit?

The swelling of the lymph nodes under your arm—known as axillary adenopathy—is a rare occurrence but can raise red flags on a mammogram as a sign of breast cancer itself or that breast cancer has spread. While this condition has very rarely been reported following injections of influenza and other vaccines, higher rates of axillary adenopathy have been reported in the two COVID-19 vaccines currently available from Moderna and Pfizer in early, self-reported data. As a result, the Society of Breast Imaging recommends that women schedule their annual screening prior to the first dose of a COVID-19 vaccine or four to six weeks after the second dose. In addition, the organization is also recommending that providers ask patients about COVID-19 vaccine status.

However, these guidelines do not suggest women skip screenings because of their COVID-19 vaccine status. Your annual screening is still a critical tool for early diagnosis. If you have received or are in the process of receiving the COVID-19 vaccine and are due for your annual mammogram soon, talk to your doctor before delaying your mammogram.

Are there any other major COVID-19 vaccine side effects that people with cancer need to be aware of?

So far, serious reactions to any of the three available vaccines have been rare. The most common side effects are pain and swelling in your vaccinated arm, along with fever, chills, fatigue, and headache. These are normal bodily responses and a sign that the vaccine is working (though it should be noted, if you don’t experience any symptoms, the vaccine is still working). Read more about what to expect after you get your vaccine here.

How else will the COVID-19 vaccine help cancer patients?

In addition to saving lives by stopping the spread of the virus and easing the considerable burden of the pandemic on the national healthcare system, the vaccines also protect cancer patients and others who are most vulnerable to infection (through herd immunity). The COVID-19 vaccines will not only help prevent infection overall, but also prevent severe illness.

Do cancer patients have a higher risk of severe COVID-19? Am I immunocompromised because of my treatments?

Cancer patients in active treatment can be immunocompromised, contributing to a higher risk of severe illness and death after a COVID-19 infection. People being treated for breast cancer may also be at a higher risk of severe illness from COVID-19 because of other, unrelated medical conditions or immunosuppressive treatments.

For breast cancer patients, chemotherapy tends not to be as toxic to the immune system (compared to chemotherapy for other kinds of cancers, like leukemia, which is generally more intense and wipes out the entire immune system). But chemotherapy can affect a patient’s ability to fight bacteria, and for that reason, they’re given injections to boost white blood cell counts.

Cancer patients whose treatment protocols involve immunotherapy have a special set of concerns. In general, immunotherapy isn’t a widespread treatment for breast cancer, but it is sometimes used for subtypes like triple-negative breast cancer. Immunotherapy can affect the lungs, potentially making patients more vulnerable to COVID-19.

Patients getting hormonal therapy may not feel completely normal during their treatments, but their immune systems are much less compromised.

The bottom line: All patients undergoing treatment should follow the CDC’s advice to protect themselves and get vaccinated. Those undergoing chemotherapy and immunotherapy should be extra cautious and consult with their doctors about additional precautions.

Are cancer survivors at higher risk for COVID-19? Are cancer survivors immunocompromised?

According to the National Cancer Institute, at this time, research has not definitively shown that a history of breast and other cancers alone increases a person’s risk of a more severe illness from COVID-19. Breast cancer survivors are not generally immunocompromised by past treatments, but they should talk to their doctors about any concerns or underlying conditions. Breast cancer survivors, however, may be at a higher risk of COVID-19 because of other, unrelated underlying medical conditions or because they are receiving immunosuppressive treatments (such as corticosteroids). It is important to discuss your immunocompromised status with your doctor.

RELATED: Breast Cancer Screening and COVID-19: What Patients Need to Know Now

What COVID-19 symptoms should breast cancer patients be on the lookout for?

The most important coronavirus symptoms to pay attention to are fever and shortness of breath. Breast cancer patients in treatment should always be on the lookout for those symptoms anyway. Call your doctor at the first sign.

Other symptoms to be aware of, according to the CDC: chills, cough, a new loss of taste or smell, fatigue, muscle or body aches, headaches, sore throat, congestion, nausea or vomiting, and diarrhea.

How will COVID-19 impact breast cancer diagnoses and care?

The full effects of COVID-19 on breast cancer diagnoses and outcomes may not be realized until long after the pandemic, but we do know COVID-19 has complicated crucial aspects of cancer care and research is predicting it will lead to more breast cancer deaths and diagnoses at later-stages, when the disease can be harder to treat.

What guidance do you have for managing stress?

We’re all living with more stress than usual. There are several helpful online tools for everything from yoga to therapy. Finding a way to feed your inner self is critical for patients and their caretakers, too. Schedule yoga, exercise, or any activity you know makes you calm. Eat healthfully, reduce alcohol, focus on a good night’s sleep.

Meditation has been shown to reduce stress and strengthen your immune system. Find several free mindfulness exercises and advice for starting a new practice from a BCRF researcher here.

This article was originally published on March 26, 2020 and has been updated since.