Nila H. Alsheik MD is currently the Chair of Breast Imaging Medical Directors at Advocate Aurora Health and the Radiology Director of the Breast Center at Advocate Lutheran General Hospital in Chicago.
Nila H. Alsheik MD is dual trained in Breast Imaging and Neuroradiology and has been in clinical practice for 10 years. Her clinical research is focused on the benefits of 3D mammography (Digital Breast Tomosynthesis), racial disparities in breast cancer screening/diagnosis, and the benefits of advanced technologies such as Breast MRI and Contrast Enhanced Digital Mammography in certain clinical populations.
Q: If I have had my Covid-19 vaccine, should I still get a screening mammogram?
A: The short answer is: “YES.” In a small percentage of patients, we are seeing that lymph nodes can appear swollen on the side that the vaccine was administered. This is known as unilateral “axillary lymphadenopathy;” in the setting of new axillary lymphadenopathy following the Covid-19 vaccine, these findings are benign and reactive, indicative of the body’s immune response to the vaccine. If you already have a screening mammogram or screening ultrasound appointment, we recommend that you keep the appointment. If you have not yet scheduled your screening mammogram or screening ultrasound appointment, we recommend that you wait until 4 weeks after the 2nd dose of the Covid-19 vaccine to schedule. This will avoid false alarms related to Covid-19 related vaccine immune response and subsequent axillary lymphadenopathy.
If you are a breast cancer survivor, we recommend Covid-19 vaccination in the arm opposite the side originally operated upon, to avoid axillary lymphadenopathy, which may mimic breast cancer in survivors. If you have had breast surgery on both sides, we recommend Covid-19 vaccination into the backside or buttocks.
Lastly, if you have new symptoms such as new lump, new nipple discharge, new skin thickening, or any new clinical symptoms, we recommend you notify your clinical provider immediately and that Diagnostic Mammogram and Diagnostic Ultrasound be performed, regardless of the timing of the Covid-19 vaccination.
A: Every breast anatomically represents a combination between fatty tissue (which appears black on the mammogram) and fibroglandular tissue (which appears white on the mammogram). When a mammogram is read by the Radiologist, the degree of fibroglandular tissue is reported in quartiles: (a) “fatty” (0-25% fibroglandular tissue), “scattered fibroglandular” (25-50% fibroglandular tissue), “heterogeneously dense” (50-75% fibroglandular tissue), “extremely dense” (75-100% fibroglandular tissue). When a Radiologist reads your mammogram, they are looking for abnormalities that appear of high density and that are mostly “white”. Therefore, in an extremely dense breast, it is as if one is looking for a snowman in a snowstorm. Masses can be hidden or obscured in heterogeneously dense or extremely dense breasts and this is why it is especially important for women with dense breasts to receive 3D mammograms and discuss adjunct screening such as whole breast ultrasound with their providers. However, notably, the scientific literature is very clear that 3D mammograms are superior regardless of the breast density. Therefore, in our health care system, nearly 100% of our patients receive 3D mammograms.