Women are now being advised to either get their annual mammograms before being vaccinated against COVID-19, or wait at least a month after their final dose to avoid a mistaken breast cancer or other cancer diagnosis due to a side effect from the shots.

The lymph nodes in the armpit area above the vaccination site can become swollen and show up on mammograms as a possible malignancy, Dr. Brett Parkinson, medical director of Intermountain Healthcare’s Breast Care Center, told reporters in Utah on Tuesday.

“Ordinarily, we don’t see enlarged lymph nodes on a mammogram or other imaging study unless there is severe pathology, either from an inflammation or malignancy,” said Parkinson, a radiologist and breast imaging specialist, explaining that is something that should occur only about 0.2% to 0.4% of the time.

That usually means a patient has metastatic breast cancer, which has traveled to the lymph nodes, or lymphoma or leukemia, But with 11% seeing swollen lymph nodes after the first dose of vaccine — and 16% after the second — Intermountain Healthcare is asking women to time their mammograms around vaccinations.

“We don’t want patients to get these false positives, to have this sort of alarm,” Parkinson said.

The new mammography recommendations came as the Utah Department of Health reported 918 new COVID-19 cases Tuesday and 10 additional deaths from the virus in the state. To date, there have been a total of 356,040 cases and 1,748 deaths from the coronavirus in Utah.

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The rolling seven-day average for positive tests is 1,095 per day. Nearly 2.1 million people have been tested for the virus in the state, an increase of 6,133 since Monday. The total number of tests conducted is just under 3.5 million, up 18,409 since Monday.

The rolling seven-day average for the percent of positive tests that do not include the results of multiple tests taken by an individual within 90 days is 15.5%. But that number drops to 7.2% when the tests conducted in the state are included in the calculation.

Tuesday’s numbers show an increase of 8,674 people vaccinated in the state since Monday, for a total of 425,698 first and second doses administered. The vaccines currently approved for use in the United States both require two doses, although there are single-dose vaccines under review.

The increase in instances of enlarged lymph nodes was first noticed about a month ago, Parkinson said. The swelling was more pronounced than what had been seen from flu and other vaccines that also trigger the body’s immune response.

Empty vials of the COVID-19 vaccine are discarded at the Mountain America Exposition Center in Sandy on Tuesday, Feb. 9, 2021, as those 70 and older are vaccinated. | Jeffrey D. Allred, Deseret News

Utah health care workers first began receiving vaccinations in mid-December, and were soon joined by first responders, long-term care facility residents and staffs, K-12 teachers and school staffs and Utahns at least 70 years old.

Starting March 1, Utah’s eligibility list for vaccinations is set to expand to Utahns 65 and older as well as those with specific medical conditions.

“We started to look at this and we realized if we don’t do something, we’re going to have a lot of patients needlessly coming back,” Parkinson said, which is costly and an additional exposure to the coronavirus for both patients and medical personnel.

A biopsy would normally be conducted to determine if cancer cells are present when lymph nodes are swollen, he said, but if a vaccine is the cause, that swelling should go away after four to six weeks. Parkinson said the post-vaccination swelling he experienced disappeared after about two weeks.

So Intermountain Healthcare has instituted a policy of encouraging patients to either get their mammograms before receiving the first vaccine dose, or to wait until four weeks after the second vaccine dose, similar to what’s being done around the country, the doctor said.

Women should not skip annual mammograms, starting at age 40, which can reduce the rate of breast cancer deaths by half. Parkinson said although almost no one sought mammograms at the start of the pandemic last March and April, the number has since increased to more than the previous year.

“We are very busy,” the doctor said, and have increased the hours that mammograms are available.

Smith’s may begin vaccine appointments

Lt. Gov. Deidre Henderson announced last week that appointments for no-cost COVID-19 vaccines for Utahns 70 and older would be available at Utah Smith’s Food and Drug and Walmart pharmacies starting Feb. 11. Smith’s may start taking appointments as soon as Wednesday, the grocery chain’s pharmacy director, Jaime Montuoro, said.

Just when Smith’s starts the online sign-ups will depend on when its pharmacies receive the 4,000 promised doses, she said, suggesting that those who want an appointment for the shots that are scheduled to start Thursday to keep checking the website,  www.smithsfoodanddrug.com/covidvaccine.

Montuoro said 39 of the 53 Smith’s pharmacies in the state are expected to offer vaccinations, but she declined to be more specific. The website directs customers to the nearest Smith’s by ZIP code, but that store may not be offering vaccinations, so those seeking appointments may need to check other locations.

“We do expect appointments will be booked pretty quickly,” Montuoro said, adding that distribution will be focused on rural and underserved communities. She said Utahns who show up at a pharmacy without an appointment will be asked to make one online.

Walmart initially is offering the COVID-19 vaccine to any Utahn currently deemed eligible by the state at 18 of its 59 Utah-based stores. Once appointments become available, they will be able to be made online, at the Walmart or Sam’s Club websites and more information is available here.

Currently there are 319 people hospitalized with COVID-19 in Utah. The 10 deaths reported Tuesday are:

  • An Iron County man, between 65 and 84, long-term care facility resident.
  • A Salt Lake County man, older than 85, long-term care facility resident.
  • A Salt Lake County man, 65-84, hospitalized at time of death.
  • A Salt Lake County man, 65-84, long-term care facility resident.
  • A Sanpete County woman, 65-84, hospitalized.
  • A Utah County woman, 65-84, hospitalized.
  • A Weber County woman, 65-84, hospitalized.
  • A Weber County woman, 45-64, hospitalized.
  • A Weber County man, older than 85, long-term care facility resident.
  • A Weber County man, 65-84, hospitalized.