Breast Cancer and COVID: Staying Safe During the Holidays
The holidays can be hard to navigate after a breast cancer diagnosis, even in non-pandemic times. Since the COVID-19 pandemic began, people living with breast cancer have faced even more difficult decisions about how to approach the season.
We have more tools to help keep us safe now than we did at the beginning of the pandemic, including vaccines, at-home tests, and oral antiviral medicines. But there are still reasons to be cautious. We don’t know the extent to which COVID-19 cases are going to spike this winter. New Omicron subvariants are circulating and we don’t know how much they are going to spread. Plus, there’s been a surge in cases of other respiratory viruses, such as the flu and RSV (respiratory syncytial virus).
Whether you are newly diagnosed with breast cancer, in active treatment, in long-term survivorship, or living with metastatic breast cancer, you may be wondering which precautions to take during the holidays. As you weigh decisions about traveling and gathering with loved ones, here’s what you need to know about navigating risk and staying as safe as possible.
Know your risk
If you’ve been diagnosed with breast cancer, there are several factors that can increase your risk of getting very sick from a COVID-19 infection — even if you are up-to-date on your COVID-19 vaccines and boosters.
A weakened immune system (being immunocompromised): People who have been diagnosed with breast cancer may be taking medicines that weaken their immune system. Treatments that can weaken the immune system include chemotherapy, certain targeted therapies, high-dose corticosteroids, and surgery. The amount of time it can take the immune system to recover after receiving these treatments varies. If you completed breast cancer treatment years or even months ago, or your treatment plan didn’t include therapies that weaken the immune system, you might not be immunocompromised. Most people who’ve received breast cancer treatment in the past are not immunocompromised because of it.
Lung problems: In rare cases, some people develop lung problems as a side effect of some chemotherapy medicines and targeted therapies. This can put them at higher risk for severe symptoms from COVID-19. Also, people with metastatic breast cancer in the lungs can have lung problems that may get worse if they develop COVID-19.
Older age: The risk of becoming seriously ill from COVID-19 is higher for people who are 50 and older, and risk increases the older you get.
Other medical conditions or disabilities: People who have certain other conditions or disabilities such as chronic lung diseases, heart disease, diabetes, and chronic kidney disease are at higher risk. Smoking or being overweight or obese also increase risk.
Not getting vaccinated: People who have never been vaccinated against COVID-19 or haven’t stayed up to date on COVID-19 vaccines and boosters are at higher risk.
Since each person's situation is unique, it's best to talk with your doctors about any factors that might put you at higher risk and which precautions you should consider taking.
“It is important to ask your medical team about any additional risk factors you may have over the average person, both for your sake and for your family,” says Julie L. Salinger, LICSW, MSW of the Dana-Farber Cancer Institute in Boston.
What can I do to increase my protection against COVID-19 before holiday gatherings and travel?
Staying up to date on COVID-19 vaccines and boosters (including the bivalent booster dose) is one of the best ways to lower the risk of being infected and infecting others. COVID-19 vaccines are safe for people with cancer. However, if you have a weakened immune system, your immune response to COVID-19 vaccines may not be as strong. Your doctors may recommend that you follow a different vaccine schedule. To learn more, read the Centers for Disease Control and Prevention’s (CDC) recommendations on vaccination for people who are immunocompromised and the National Comprehensive Cancer Network’s (NCCN) vaccination guide for people with cancer.
Another important way to lower your risk is to wear a well-fitted mask that fits snugly over your mouth, nose, and chin when you’re in public indoor settings, gathering indoors with people from outside your household, or taking public transportation. NIOSH-approved N95 respirators (approved by the National Institute for Occupational Safety and Health) are more protective than cloth masks or disposable surgical masks. Many healthcare providers recommend Projectn95.org as a trustworthy non-profit resource for ordering masks.
How can I gather with loved ones as safely as possible?
If you are thinking about traveling or gathering indoors with people from multiple households this holiday season, much of the general advice on lowering the risk of catching or spreading COVID-19 remains the same as it has for the past couple of years:
Check the local rates of COVID-19 and other viral illnesses in the community where you are or plan to travel. Consider canceling plans if those rates are rapidly increasing. The CDC tracks COVID-19 levels in each county in the United States and classifies levels as low, medium, or high.
Inviting a smaller number of people to a holiday gathering is safer than inviting a larger number of people.
Encourage the people you’re gathering with to stay up to date on COVID-19 vaccines and boosters (including the newer bivalent booster dose) and flu shots.
Before gathering indoors, ask guests to take an at-home COVID-19 test. The CDC has tips on when and how to self-test. Make sure everyone invited to the gathering knows to stay home if they have tested positive for COVID-19, have any symptoms of COVID-19, or might have been exposed to someone who has COVID-19.
Gather in larger rooms or areas of your home where people can be spaced apart more.
Increase the ventilation in your home by opening windows and doors, using air purifiers, and turning on fans.
If you prefer to be more cautious, have guests wear masks indoors and move the eating and drinking outside.
As an alternative to meeting in person, you may want to consider hosting a virtual holiday celebration. You could set a time that works for everyone and structure the event around one or more activities, such as virtually sharing a meal, playing Bingo or trivia, opening gifts, or watching a movie together through a group streaming service such as Teleparty.
Regardless of personal levels of risk, it’s important for loved ones to respect what each individual is comfortable with, says Elizabeth Robilotti, MD, MPH, assistant attending physician at the Hospital for Special Surgery and assistant professor of medicine at Weill Cornell Medical College.
“One of the most important messages about celebrating the holidays safely and happily is being respectful of everybody’s boundaries, and not wanting to put anyone in a position where they feel they have to be in the room if they’re not ready to do so,” she says.
But everyone’s relatives and friends don’t think alike. It can be difficult to discuss why your level of risk or tolerance may differ. But it’s important to have these conversations, especially to make sure your loved ones know that they should stay home if they are feeling sick, or if they have or may have come into contact with someone who is sick.
It’s crucial for you to feel comfortable communicating what is best for you.
Visit Breastcancer.org’s online community and discuss the effects of COVID-19 with other people affected by breast cancer.
Read tips from community members about coping with isolation during the COVID-19 pandemic.
And learn more about managing breast cancer, COVID-19, and the winter blues.
— Last updated on February 15, 2023 at 1:58 PM