Breast Cancer and the COVID Vaccine: What you Need to Know

Women who are being treated for breast cancer, were recently treated, or have survived the disease, should get the COVID vaccine as soon they can, according to Carla Falkson, M.D., leader of the breast cancer service line at the Wilmot Cancer Institute.

“I can’t emphasize enough that if we can build herd immunity, the coronavirus won’t be able to divide and produce variants,” Falkson said. “I really believe we should all get the vaccine. Your close contacts, household members, anyone you interact with regularly, should also be vaccinated. We need to protect each other.”

Falkson spoke to an audience of more than 200 people at a virtual community event organized by the Breast Cancer Coalition of Rochester (BCCR) on Feb. 24, 2021.

Here are the key messages she delivered about the COVID vaccine and breast cancer — with a few caveats and explanations:

• The Pfizer and Moderna vaccines, which use mRNA technology, are “definitely safe for our cancer patients,” and are also safe while they are receiving chemotherapy, she said. Both vaccines have been approved by the U.S. Food and Drug Administration (FDA), and are available in New York state.

• In general, cancer patients who are immunosuppressed while receiving chemotherapy should not take vaccines made with live, weakened viruses. The AstraZeneca vaccine was developed by using a modified, live, Simian replicant deficient adenovirus; the Johnson & Johnson vaccine was developed using a replicant deficient live human adenovirus 26 vector. While the AstraZeneca vaccine has not been authorized yet for use in the U.S., the Johnson & Johnson vaccine was approved on Feb. 27. As more information about those vaccines become available, experts will update their advice on safety and efficacy in cancer patients who are receiving chemotherapy.  Because cancer patients with suppressed immune systems from chemotherapy were not included in COVID vaccine clinical trials, data is currently scarce, Falkson said.

• Will the COVID vaccine interact with, or interfere with, hormonal therapies commonly prescribed for breast cancer, such as aromatase inhibitors? No. The vaccine is appropriate for these women.

• When should I get the vaccine if I’m receiving chemotherapy? The optimal timing is unknown. In the absence of data, Falkson said, the National Comprehensive Cancer Network (NCCN) recommends that patients get the coronavirus vaccine whenever possible. Ideally, get the shot before chemotherapy starts. Having a low white blood count during a chemotherapy cycle should not significantly impact the immune response to the vaccine. (Falkson noted that individuals with leukemia or lymphoma should talk to their oncologists about this concern.)

• What about radiation therapy? It’s okay to get the vaccine while receiving this treatment.

• What is the best time to get the COVID vaccine around breast cancer surgery? If possible, get the vaccine before surgery. If that’s not possible, wait a few days after surgery, to avoid confusion about post-surgical symptoms (fever) versus post-vaccine symptoms, she said.

• For women with breast cancer who’ve had surgery and perhaps also lymph node removal, which arm is best for getting the shot? If possible, use the arm that was not impacted by surgery. But if you’ve had surgery on both sides, either arm is fine, Falkson said. It’s okay to get both vaccine doses in the same arm.

• What about women who have lymphedema (swelling) of the arm due to lymph node removal? If the lymphedema is not in both arms, then get the vaccine in the unaffected limb. If swelling is a problem in both arms, speak to your oncologist about getting the COVID vaccine injection in another muscle, she said. 

• What about women who are years past treatment? Falkson still recommends that they get the COVID vaccine as soon as possible, and encourages them to find out if they may qualify due to other risk factors, such as age or a comorbidity.

• Is the vaccine safe, effective and worth it, even if a cancer patient mounts a lower immune response to coronavirus? Yes. Although vaccine efficacy can vary depending on type of cancer and extent of disease, any amount of protection is better than no protection, she said. All people with cancer, and those who have recently completed treatment, appear to have a much higher incidence and risk for severe COVID infections. “You don’t want to have cancer and COVID,” Falkson said.

• After vaccination, the full duration of immunity from COVID is unknown. For that reason, Falkson emphasized that cancer patients should pay particular attention to hand-washing, wearing a mask, and social distancing, even after fully vaccinated.

Falkson also cautioned the BCCR audience that postponing cancer screenings and treatment during the pandemic is a concern for oncologists, as it could lead to more cases of advanced cancer.  Falkson is a professor of Medicine, Hematology/Oncology, director of Wilmot’s Breast Oncology Clinical Research Program, and medical director of the Pluta Cancer Center.

Watch the full BCCR presentation: