Should Breast Cancer Patients get the Flu Vaccine?

Kevin Knopf, MD Health Guide
  • I strongly recommend flu vaccination for breast cancer patients because it decreases your chance of getting the flu. I have only one small caveat, but please check with your own oncologist as she or he may have a different opinion.

    The traditional saying that cancer patients are “immunosuppressed” arose from the work with leukemia patients who, by the nature of their cancer, often do not produce enough good white blood cells. Breast cancer patients who are in remission, receiving radiation therapy alone, or are on hormonal therapy alone are not immunosuppressed, in my opinion.

    The first caveat is that breast cancer patients can become immunosuppressed during chemotherapy but this is usually only for a few days at a time. For example, for women receiving adjuvant chemotherapy on a 21-day regimen such as AC - Adriamycin/cytoxan or TAC - taxotere/adriamycin/cytoxan the white blood cell count is likely to be lowest around days 10-14 (when I usually bring my patients back for a visit and blood count). With the use of growth factors like G-CSF or pegylated G-CSF (Neulasta), I rarely see a drop in the white blood cell count even during days 10-14. “Dose dense” adjuvant chemotherapy is usually given with Neulasta and so drops in blood counts are also rare.
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    I recommend the intramuscular form of flu vaccine is inactivated, so I don’t perceive a risk of “catching flu” from an inactivated vaccine. I would avoid the intranasal flu vaccine.

    It makes most sense to not get the flu vaccine on a day when your white blood cell count is low, not because there is risk to you but because you might not mount the appropriate immune response to the flu vaccine that you want, and then the effectiveness of the vaccine might be lower.

    So it is good to have a normal white blood cell count when you get the flu vaccine. Traditionally, I have recommended getting the flu vaccine 1 to 3 days before the next cycle of chemotherapy when the white blood cell count should be normal.

    Have a Happy Thanksgiving everyone!
Published On: November 16, 2006