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

Answers to common questions about navigating COVID-19 and breast cancer
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More than a year into the COVID-19 pandemic, patients with breast cancer, survivors, and loved ones are still dealing with layers of fear and uncertainty about staying safe and healthy, undergoing treatment, and securing a vaccine.

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

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

EDITOR'S NOTE: On Tuesday, April 13, the federal government recommended that states temporarily pause their use of the Johnson & Johnson Janssen vaccine while officials investigate six cases of extremely rare (less than one in one million) blood clots and whether those clots were linked to the vaccine. We will update this page further after the Advisory Committee on Immunization Practices releases their recommendations.​

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. This means that you are able to develop immunity against COVID-19 without being exposed to it. The approved two-dose Pfizer/BioNTech and Moderna vaccines do this with mRNA technology, while the one-dose Johnson & Johnson’s Janssen shot is a vector vaccine. None of the vaccines will give you COVID-19. You can read more about the types of vaccines (mRNA, vector, and protein subunit) being tested and considered here.

How effective are the COVID-19 vaccines? Are they as effective for breast cancer patients?

The leading COVID-19 vaccines have reported efficacies (how well they prevent COVID-19 infection and severe disease) of up to 95 percent with minor side effects. In clinical trials, Pfizer/BioNTech reported 95 percent efficacy and Moderna reported 94 percent. A recent real-world study of 4,000 healthcare workers showed that these vaccines were 90 percent effective. No one in the study who was infected died from COVID-19.

In clinical trials, Johnson & Johnson’s Janssen vaccine, which only requires one dose, was found to be 77 percent effective in preventing severe COVID-19 at least 14 days after vaccination. Four weeks after vaccination, the efficacy against severe disease increased to 85 percent, and the vaccine then prevented hospitalizations and deaths from COVID-19.

Nearly all phase III clinical trials of COVID-19 vaccines excluded people who were being treated for cancer, so data about efficacies for this particular group are not yet available. 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 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: Talk to your healthcare team about your options and any concerns.

How long does it take the vaccines to reach full effectiveness?

According to the CDC, it generally takes two weeks for vaccines to provide maximum immunity. This means that you are not considered fully vaccinated against severe COVID-19 until two weeks after the second dose of the Pfizer-BioNTech or Moderna vaccines or two weeks after the one-dose Johnson & Johnson/Janssen vaccine. During that time, you can still contract COVID-19, so it’s important to continue to follow all basic precautions.

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.

Can I resume my normal activities and stop wearing a mask after vaccination?

Even fully vaccinated Americans are advised to continue wearing a mask, practice social distancing, wash hands, and avoid crowds and poorly ventilated spaces. These guidelines should be followed when you are in public spaces or are around unvaccinated people—particularly those who are at a higher risk of severe COVID-19.

Fully vaccinated people, however, may begin to gather with other fully vaccinated people without masks or social distancing. The CDC says fully vaccinated people can also see unvaccinated people under the same conditions, so long as no one in the group is at a high risk for COVID-19. Travel testing requirements have also eased for this group. Read more here.

Do the vaccines work against the new COVID-19 variants?

Researchers are investigating how effective the current vaccines are against several known variants, including those first discovered in the United Kingdom, South Africa, and Brazil that are the CDC’s top three “variants of concern.” Very preliminary data suggest current vaccines could still prevent severe COVID-19 leading to hospitalizations and deaths even with reduced effectiveness, but far more research is needed.

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 COVID-19 vaccine 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 (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.

EDITOR'S NOTE: On Tuesday, April 13, the federal government recommended that states temporarily pause their use of the Johnson & Johnson Janssen vaccine while officials investigate six cases of extremely rare (less than one in one million) blood clots and whether those clots were linked to the vaccine. We will update this page further after the Advisory Committee on Immunization Practices releases their recommendations.

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. One study looking at data from Columbia University Irving Medical Center found that more than 40 percent of breast cancer patients experienced a COVID-19–related care delay between February 1, 2020 and April 30, 2020.

A study published in August 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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