COVID-19 Vaccinations: What to Expect When a Mammogram Reveals Swollen Lymph Nodes in Women

Radiologists at Massachusetts General Hospital (MGH) have published an approach in the American Journal of Roentgenology to manage what they expect to be a fairly common occurrence as COVID-19 vaccination programs ramp up.

The objective of the publication is to avoid confusion among patients and their providers and to avoid delays in vaccinations or recommended mammograms through the pandemic. Swelling of lymph nodes in the armpit area is a normal response to COVID-19 vaccinations, but when they are seen on mammograms, they can be mistaken for nodes that are swollen because of cancer, according to the study authors.

“We had started to see more patients in our breast imaging clinic with enlarged lymph nodes on mammography, ultrasound, and magnetic resonance imaging. And we noticed they were coming to our clinic after a recent COVID-19 vaccination,” said lead study author Constance Lehman, MD, PhD, director of Breast Imaging and co-director of the Avon Comprehensive Breast Evaluation Center at MGH, in a press release. “We talked with our colleagues in primary care and in our breast cancer specialty clinics and realized we needed a clear plan for management.”

The research team wanted to develop a program that supported patients to continue to engage in vaccination programs while also ensuring that patients continued to receive their routine health care needs, such as breast cancer screening. In addition, it was important to reassure patients that swollen lymph nodes in the armpit is a normal and expected finding after vaccination, according to the study authors.

The group’s approach is based on 3 principles:

• Encouraging COVID-19 vaccination.
• Reducing and/or eliminating delays, cancellations, and rescheduling of breast imaging exams.
• Reducing unnecessary additional imaging and/or biopsies of lymph nodes that have become swollen from recent vaccination.

“In addition to avoiding delays in vaccinations and breast cancer diagnoses, we hope that our model will reduce patient anxiety, health care provider burden, and costs of unnecessary evaluations of enlarged lymph nodes after vaccinations,” Lehman said in a press release.

The study authors note that no additional imaging tests are needed for swollen lymph nodes after recent vaccinations unless the swelling persists or if the patient has other health issues. Since the message is recommended to be communicated to both imaging staff and patients, the researchers said that a patient letter may read: “The lymph nodes in your armpit area that we see on your mammogram are larger on the side where you had your recent COVID-19 vaccine. Enlarged lymph nodes are common after the COVID-19 vaccine and are your body’s normal reaction to the vaccine. However, if you feel a lump in your armpit that lasts for more than six weeks after your vaccination, you should let your health care provider know.”

“This disruption of breast cancer screening is likely to result in a significant increase in cancers diagnosed at late stages and an increased demand for cancer screening procedures as delayed tests are rescheduled,” Lehman said in a press release. “We believe our model can avoid reducing or delaying vaccinations and avoid further reduced or delayed breast cancer diagnoses based on confusion amongst patients and/or their providers.”

REFERENCE

What to do when a mammogram reveals swollen lymph nodes in women recently vaccinated for COVID-19. Massachusetts General Hospital. https://www.massgeneral.org/news/press-release/What-to-do-when-a-mammogram-reveals-swollen-lymph-nodes-in-women-recently-vaccinated-for-covid19. Published February 24, 2021. Accessed March 1, 2021.