Rebecca HSU, MD
Diagnostic Radiologist
Scripps MD Anderson Cancer Center and Scripps Clinic

Scheduling an annual screening mammogram remains the best way to detect any early signs of breast cancer. However, some people have had questions about scheduling a mammogram during the COVID-19 pandemic. How safe are health facilities? Can I postpone my mammogram? Can the COVID-19 vaccine affect my mammogram?

Let’s start with what hasn’t changed. Breast cancer is still the second most common cancer among women in the United States according to the Centers for Disease Control and Prevention (CDC). Research shows it is easier to treat breast cancer when it is caught early. A screening mammogram is used to look for signs of breast cancer in women who don’t have any breast symptoms or problems.

Health care facilities, like those at Scripps, are still safe places for mammograms, with enhanced precautions in place to protect patients, doctors, nurses and staff from potential exposure to the coronavirus.

“If you are overdue for one, we encourage you to schedule your annual screening mammogram and work with your doctor if you have any questions,” says Rebecca Hsu, MD, a diagnostic radiologist at Scripps MD Anderson Cancer Center and Scripps Clinic. “Regular mammograms are the best tests doctors have to find breast cancer early.”

COVID vaccine and mammograms

If you are unable to schedule your screening mammogram before receiving the COVID-19 vaccine, doctors recommend having your mammogram done a minimum of four weeks after receiving your second vaccine dose. This applies to two-dose vaccines by Moderna and Pfizer.

The reason for this recommendation is that some women who receive these vaccines develop swollen lymph nodes, usually under the arm on the same side of the body where the vaccine was injected. This is a normal immune reaction to the vaccine and generally subsides within four weeks. It’s not yet known if the recently approved Johnson & Johnson vaccine may have a similar effect.

Scripps experts are raising awareness about timing considerations for scheduling screening mammograms and the COVID-19 vaccine.

“Because enlarged lymph nodes can be seen on mammograms, patients due for their annual screening mammograms are encouraged to schedule their mammograms either before they have received the first dose of the vaccine or at least four weeks after they have received the second dose. This will reduce the chances of getting called back for additional imaging due to the enlarged lymph nodes,” Dr. Hsu says.

Under normal circumstances, swollen lymph nodes are a sign of breast cancer and would raise concern appearing on a mammogram and would require further testing.

If you get vaccinated first and do not want to miss a scheduled mammogram, make sure to tell your doctor about your vaccination to help get the most accurate mammogram reading.

Is it safe to delay a screening mammogram?

For patients of average risk, postponing an annual screening mammogram a month or two during the pandemic should not affect the risk of breast cancer.

“If you are significantly overdue for a mammogram, it is especially important to make and keep your mammogram appointment,” Dr. Hsu says.

A delay is only recommended for screening mammograms, where the patient has no breast cancer symptoms. There should be no delay if the patient has symptoms. A diagnostic mammogram is used to look at a woman’s breast if she has breast symptoms or if a change is seen on a screening mammogram.

A diagnostic mammogram may include extra views of the breast that aren’t part of screening mammograms.

You should contact your doctor right away if you notice changes in your breasts or are experiencing unusual symptoms.

Be on the lookout for the warning signs of breast cancer. Consult with your doctor if you develop any of these symptoms:

• Bloody or clear nipple discharge that occurs without squeezing the nipple
• Breast dimpling or puckering
• Swollen, red or warm breasts
• Changes in size or shape
• A hard knot or thickening in the underarm area or inside the breast
• A scaly, itchy rash or sore on the nipple
• Inversion (pulling inward) of the nipple or breast
• Pain in one spot that doesn’t go away in two to three weeks

How safe are breast care locations?

If you’re a Scripps patient, don’t hesitate to schedule a doctor’s visit to discuss a medical issue, change of health status or for a preventive visit, including a mammogram, due to concerns about COVID-19.

“We have extensive safety procedures and protocols in place to protect patients, doctors, nurses, staff members and anyone else who enters a Scripps facility,” says Ghazala Sharieff, MD, MBA, Scripps chief medical officer, clinical excellence and experience.

Those safety precautions include:

• Curbside check-in through the MyScripps mobile app
• Asking that patients visit their doctor without a companion, if possible
• Screening for everyone entering a facility
• Requiring all physicians, staff members, patients and visitors to wear face masks or coverings
• Rigorous cleaning and disinfecting protocols for all facilities and equipment

Steps you can take to protect yourself from COVID

In addition to wearing a face covering, you can take other steps to reduce your risk when you go to your doctor’s office, including:

• Practice social distancing in waiting rooms.
• Practice proper hygiene by washing your hands frequently with soap and warm water for at least 20 seconds.
• Use hand sanitizer before and after your visit.
• Avoid touching communal surfaces in the office, such as doorknobs and elevator buttons, as much as possible.
• Avoid touching your face, eyes, nose and mouth.
• Do not come in if you are feeling sick or have a fever or cough.

While a mammogram takes only a short while to complete, it does involve close contact between a patient and medical professional.

“We have safety measures in place for every step of your visit and we encourage you to ask questions about how we do breast imaging,” Dr. Hsu says.

To Your Health is brought to you by the physicians and staff of Scripps. For more information, please visit www.scripsps.org