Although the management of breast cancer has been impacted by the COVID-19 pandemic, the cancer care team has developed strategies to optimize screening and treatment experiences in spite of these challenges. In this interview, Lillie Shockney, RN, BS, MAS, HON-ONN-CG, Professor of Surgery at Johns Hopkins University and member of the National Breast Cancer Foundation Medical Advisory Council, shares advice advice regarding protocols for undergoing mammograms during the pandemic, including the timing of COVID-19 vaccination.
This interview has been conducted in partnership with the National Breast Cancer Foundation (NBCF). Recognized as one of the leading breast cancer organizations in the world, NBCF is Helping Women Now® by providing early detection, education, and support services to those affected by breast cancer. A recipient of Charity Navigator's highest 4-star rating for 14 years, NBCF provides support through their National Mammography Program, Patient Navigation, breast health education, and patient support programs. For more information, please visit https://www.nationalbreastcancer.org/
Oncology Data Advisor: Welcome to Oncology Data Adviser. In this interview, Lillie Shockney, professor of surgery at Johns Hopkins University, will be discussing advice for breast cancer treatment during the COVID-19 pandemic. Thank you so much for joining us today.
Lillie Shockney, RN, BS, MAS, HON-ONN-CG: Thanks for having me.
Oncology Data Advisor: What are some of the greatest challenges surrounding the COVID-19 pandemic?
Lillie Shockney: Each time this virus mutates, it becomes more aggressive, easier to transmit, and more deadly. It's important to not get your screening mammogram within six weeks of getting your last vaccine. For the Moderna and Pfizer vaccines, which require two shots, you want to wait until six weeks after your second vaccine. For Johnson & Johnson, which is one shot, you want to wait until six weeks after that one vaccine was given to you. The reason why is that these vaccines do as they were intended: they turn on the immune system. That's how they work. In turning on the immune system, they also turn on our lymphatic system, because the lymphatic system is how we fight infection. It's also how we fight initially cancer; those lymph nodes are out there to fight and grab hold of infection and try to prevent it from going elsewhere, making us even sicker.
When a woman goes in for a screening mammogram, if nobody asked her, "Have you had your COVID vaccine?" and if she doesn't say, "By the way, I had my COVID vaccine three weeks ago. Should I tell anybody?" Nobody usually talks about it. Nobody usually brings up that topic when they're supposed to. So they do her mammogram, and if the mammogram technician did a really good job—she didn't just capture all of her breast tissue in those two paddles when she squeezed it, but she also got the upper outer quadrant of her breast that's closest to her underarm—she should be seeing some lymph nodes in there. If the vaccine for COVID was given to that patient within six weeks of that screening mammogram, those lymph nodes will light up and look like they've got cancer in them.
So what happens? The mammogram technician goes, "Uh oh," and shows that to the radiologist, who goes, "Uh oh. Let's get more imaging done. I don't see anything in the breast, but there must be something in there because she's got positive lymph nodes." She'll even get a biopsy of those lymph nodes. She'll be told, "It looks like you have breast cancer, but we can't find the tumor in the breast." Well, now let's look at the other breast. Between 2% and 3% of the time, we can actually have a very rare finding of a breast tumor in the opposite breast with the lymphatic system crisscrossing and going over to the other armpit. It's very rare, but it happens. When it happens to you in the case of a recent COVID vaccination, it's 100% for you. Now they're doing more imaging, imaging, imaging.
Now let's send her for a breast magnetic resonance imaging (MRI). Well, we can't get her on the schedule for four days. For four days she tells everybody, "They told me I've got breast cancer. They can't find it. I don't know what's going to happen. I don't know what kind of surgery I have to get. I guess I have to get chemotherapy, because it's already in my lymph nodes, and what if it's in my lung, my bone, my liver?" She has had 10 years of her life scared out of her because nobody said, "Have you had your vaccine? And if so, when?"
So I need that woman to speak up. If she's scheduling her screening mammogram herself, she needs to wait and book it so that when it is scheduled, it is at least six weeks after the vaccine. I get email after email every single day from women that I don't know, but they find me on the internet because I am well-known in this field, and they will say, "I just was told I have breast cancer, and they can't find the tumor, but it's already in my lymph nodes. What should I do?" I'll write back, "When did you have your COVID vaccine?" They'll say, "Two weeks ago."
"I have good news," I'll say. "You're not going to have anything done. You're going to wait until you're well past six weeks, and you're going to get this mammogram and ultrasound redone, and I think you'll get good news. Don't let them stick anything in you when this is all a false alarm, absolutely a false alarm."
We do still need to be careful in wearing masks. When they go in to get their mammogram, they probably will be expected to be masked. Your mammogram technician also should be masked. The radiologist reading the imaging is also masked. I encourage them to wear it in. They should be stopped right at the door if they aren't wearing one. It should be one that fits properly, that covers the bridge of their nose. It has a piece of metal in it that they can pinch so that it fits snugly over their nose: no gaps on the side, which I'm chronically seeing, because it's not a well-fitted mask. There should be not one or two, but three layers of fabric, or it could be one of the KN-95 masks, which are excellent and are available on Amazon. I would not purchase an N95. First, they're several hundred dollars. Number two, we need to preserve those for the health care workers that are working in the intensive care units and taking care of patients that have COVID and are critically ill. But mask up, please, when you go in for your mammogram.
Don't delay getting your annual mammogram. COVID has been used as an excuse, too. "I'm not going to go in until COVID is all gone." Well, it's been a year and a half, and it's not all gone and it's not going to be all gone in the next few months. We're going to be living with this well into 2022, maybe even to the end of 2022.
About Lillie Shockney
Lillie Shockney, RN, BS, MAS, HON-ONN-CG: her name is well known in the cancer field, especially in navigation, survivorship, patient-centered care, preservation of quality of life, end-of-life planning and care, and improving the cancer patient's experience and clinical outcomes. She clinically specializes in breast cancer care. Her public speaking, literary work, and notable roles over the last 40+ years are well known to many:
•University Distinguished Service Professor of Breast Cancer (2016-present)
•Former Administrative Director, Johns Hopkins Breast Center (1997-2018)
•Former Director, Johns Hopkins Cancer Survivorship Programs (2011-2018)
•Professor of Surgery, Johns Hopkins University School of Medicine (2016-present)
•Co-developer and medical advisory of Work Stride: Johns Hopkins Managing Cancer at Work
•Co-founder, Academy of Oncology Nurse Navigators (AONN+) (2009-present)
•Former Program Director of AONN+ (2009-2019)
•Editor-in-chief of the Journal of Oncology Navigation and Survivorship (2012-present)
•Author of 20 books and >350 articles on various cancer topics
•National and international public speaker (1997-present)
A two-time breast cancer survivor, originally diagnosed in her 30s, Lillie has worked tirelessly to improve the care of breast cancer patients around the world. She has worked at Johns Hopkins since 1983. Lillie takes great pride in the AONN+, which as of April 2020, has more than 8,900 members. She has served as a consultant for breast cancer for national ABC News and Good Morning America and has been also consulted regularly by the Today Show and CNN. Lillie serves on 28 medical advisory boards currently. In 2008, the President of The Johns Hopkins University and their Board of Trustees appointed her to a Distinguished Service Faculty Chair. This is the first and only time in the history of the institution that a hospital nurse has been appointed to a distinguished service designation. She continued to climb the academic ladder and in 2016 was promoted to full professor. She is the only nurse at Johns Hopkins to have a primary faculty appointment in the School of Medicine and the only nurse in the country to have reached the highest academic faculty ranking and be appointed to a faculty chair as a University Distinguished Service Professor of Breast Cancer at Johns Hopkins University School of Medicine.
She has received 61 awards—54 national awards and 7 state awards, including being inducted into the Maryland Women Hall of Fame, Women in Business Healthcare Trailblazer Award, Johnson & Johnson's Most Amazing Nurse in America award, National Komen for the Cure's Professor of Survivorship award, and several national lifetime achievement awards. Her research area of focus is preservation of quality of life for patients with metastatic breast cancer. Currently, a documentary is being made about her life and her life's work. She tells people she never forgets where she came from—she will always be "a farmer's daughter."
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.