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

Answers to common questions about navigating COVID-19 and breast cancer
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During these uncertain times, everyone’s wondering what they should do to stay healthy and how to protect themselves from COVID-19 (coronavirus). Many of us have the same questions on our minds: What are the symptoms of COVID-19? Who is at risk of contracting COVID-19? Should I get the COVID-19 vaccine? Patients with breast cancer and other cancers have an extra layer of fear, as they navigate concerns about immunity and the safety of continuing treatment.

While the best advice for getting diagnosed or treated for breast cancer during the coronavirus pandemic is to talk to your doctor, below you will find expert guidance on some common questions.

This page is continuously being updated as recommendations evolve and new developments break.

How can I protect myself from COVID-19?


Everything medical experts have recommended is what everyone—including cancer patients—should be doing. Wear a mask when you are not home. Review the CDC’s recently updated guidelines for mask fit, filtration, and layering to ensure you are maximizing the potential of your mask. Wash your hands and avoid touching your face. Avoid contact with people outside of your household, crowds, and poorly ventilated spaces as much as possible. When unavoidable, maintain at least a six-foot distance from others while wearing a mask. Try to be as hygienic as possible, wiping down surfaces and cleaning your house regularly.

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. You can read more about the types of vaccines (mRNA, vector, and protein subunit) being tested and considered here.

Are COVID-19 vaccines safe for breast cancer patients? Are they effective?


The leading COVID-19 vaccines have reported efficacies of up to 95 percent with minor side effects. Nearly all phase III clinical trials of COVID-19 vaccines—including those from Pfizer/BioNTech, Moderna, and AstraZeneca—excluded people who were being treated for cancer, so data about efficacies for this particular group are not yet available. Johnson &Johnson/Janssen’s phase III trials did not exclude people with cancer, but data is not yet available on this group, and the single-dose vaccine is under FDA review.

Cancer treatments such as chemotherapy and radiation suppress the body’s immune system. Without data from clinical trials, we do not yet know if the vaccine will be as effective for patients receiving immunosuppressive cancer treatments or whether these patients could have any unique side effects.

Experts have said cancer patients likely will not receive the maximum immunity of up to 95 percent. “But even if it’s 50 percent, it’s still going to be a major benefit,” said Steven Pergam, MD, of the Vaccine and Infectious Disease Division at the Fred Hutchinson Cancer Research Center in Seattle, who helped write the National Comprehensive Cancer Network’s recommendations for COVID-19 vaccination in cancer patients.

As reported in The ASCO Post, Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, said cancer patients should be encouraged to get the COVID-19 vaccine. "[Cancer patients] will probably have a lesser degree of immunity,” he said. “We don’t know now how much immunity we can induce with the vaccine. That is why we argue for healthy people to get vaccinated to develop herd immunity to protect those who are immunocompromised."

The most important takeaway: When vaccines become widely available, talk to your healthcare team about your options.

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


Early information indicates that the leading vaccines will be 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.

Are cancer patients prioritized for COVID-19 vaccines?


The CDC has recommended that people aged 16 to 64 with “underlying medical conditions [that] increase the risk of serious, life-threatening complications from COVID-19” be vaccinated in phase 1C, along with all people over the age of 65 and in addition to previous groups (people over 75 and frontline essential workers). Cancer has been identified as one of these high-risk medical conditions.

While the CDC has made this recommendation, individual states are following their own vaccination rollout plans that may be different. If you are wondering if you can be vaccinated where you live as someone with cancer, contact your local health department.

BCRF has joined 130-plus scientific organizations and cancer centers in sending a letter to President Biden underscoring the importance of prioritizing cancer patients and survivors in the COVID-19 vaccine rollout. Read the letter here.

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 is now recommending 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 side effects that people with cancer need to be aware of?


So far, serious reactions to either of the 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. 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 upcoming mass vaccination effort will 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. Experts also hope that vaccines will encourage Americans to get their annual cancer screenings—one of the best tools doctors have to detect the disease early.

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


The National Cancer Institute reports that cancer increases a person’s risk of severe illness from COVID-19, so it is critical for all patients to take steps to protect themselves. Cancer patients in active treatment can be immunocompromised, contributing to a higher risk of severe illness. 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 limit the spread of the virus. 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.

Should I continue to go to chemotherapy and radiation treatments?


It’s fair to be concerned about getting treatment during the pandemic. Hospitals and treatment centers are aware of this and have put extra precautions in place to protect patients and staff. Things have changed since the start of the pandemic. By and large, it is safe to go to the doctor or a hospital, as long as you wear a mask and practice social distancing from other patients.

Your treatment is important. Most of the time, doctors will try to keep treatments on schedule. But again, consult with your doctor about whether he or she advises any modifications.

What about mammograms and other routine screenings?


Early in the pandemic, hospitals and screening facilities closed due to COVID-19, and many women had their routine mammograms postponed or canceled. Patients showing symptoms of breast cancer did not experience large-scale disruptions.

If your doctor agrees, it is now safe to get your routine mammogram. Since those initial closures, screening facilities have changed their waiting room layouts, check-in processes, cleaning procedures, and more, to make mammograms safe. If everyone is wearing a mask, your risk of contracting COVID-19 is low. Still worried? Make an early morning appointment to cut down on time in the waiting room. And if your mammogram was canceled, call to reschedule as soon as possible.

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.

Recent research indicated a significant decline in breast cancer diagnoses (by as much as 51.8 percent) in the U.S. from March 1 to April 18, causing some experts, including BCRF’s Founding Scientific Director Dr. Larry Norton, to warn of a coming "tsunami" of diagnoses, potentially at more advanced stages. In the June 2020 issue of Science, Dr. Norman E. Sharpless, director of the U.S. National Cancer Institute (NCI), wrote: “There can be no doubt, that the COVID-19 pandemic is causing delayed diagnosis and suboptimal care for people with cancer.” NCI forecasts, highlighted in his article, suggest that over the next decade, the pandemic will result in nearly 10,000 additional deaths due to breast cancer and colorectal cancer.

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.

Thanks to BCRF’s Scientific Director Dr. Judy Garber and researchers Dame Lesley Fallowfield and Drs. Wendie Berg and Julienne Bower for lending their expertise to this piece.

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

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

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