Mandy Prahl, of Elkhart Lake, couldn’t believe what she heard. When she noticed a lump in her breast “no bigger than the tip of an eraser,” she alerted her doctor, who ordered an ultrasound. She was at work when she got the test results: cancer. “I was shocked,” she said. “I was 30. It didn’t make sense to me.”

Struggling to process the diagnosis, Mandy got a second opinion at the Froedtert & the Medical College of Wisconsin Clinical Cancer Center at Froedtert Hospital campus, part of the Froedtert & MCW Cancer Network.

“My parents had been involved in a car crash several years ago and were treated at Froedtert Hospital,” she said. “They were very happy with the physicians they encountered, so I started to look there. As soon as I read the bio of Dr. Kong, I wanted to see her. I felt very strongly that she could help me. I was completely overwhelmed, but she was so calm. She said, ‘This is your situation, and this is what I can do to help you.’”

Breast surgical oncologist Amanda Kong, MD, MS, determined that the tumor had spread to the lymph nodes in Mandy’s armpit. She brought Mandy’s case to a breast cancer conference where a multidisciplinary team of specialists discussed the nuances of her disease before designing a treatment plan personalized to her situation. That plan included surgery, chemotherapy, consideration of clinical trials and, suspecting a familial cancer connection, referral to a genetic counselor. Mandy was also referred to medical oncologist Colin Mooney, MD, who initiated a five-month course of chemotherapy. Dr. Mooney sees patients at the Froedtert & MCW Kraemer Cancer Center at St. Joseph’s Hospital campus, which is closer to Mandy’s home and work.

“I chose the Froedtert & MCW Cancer Network because the treatment is so personalized and advanced,” Mandy said. “Dr. Mooney was wonderful. He gave me good advice — like exercise is the best way to combat fatigue. Whenever I had a question, he took the time to educate me.”

Mandy also completed genetic testing, which revealed she has the BRCA2 mutation. This mutation increases the risk for breast and gynecologic cancers.

“Once I knew about the mutation, I decided to have a double mastectomy,” she said. Plastic and reconstructive surgeon John LoGiudice, MD, performed her reconstructive surgery. As a preventive measure, gynecologic oncologist Erin Bishop, MD, removed Mandy’s ovaries a year later.

Clinical Trial 

Before breast surgery, Dr. Kong offered Mandy the opportunity to participate in the Alliance 11202 clinical trial sponsored by the Alliance for Clinical Trials in Oncology, in collaboration with the National Cancer Institute.

“For women like Mandy whose lymph nodes have been affected, the standard is to remove all the lymph nodes,” Dr. Kong said. “But European data shows that, in terms of survival outcomes, radiation therapy to the armpit is equivalent to removing all the lymph nodes. In addition, with this approach, there are fewer instances of the arm swelling called lymphedema that can occur with removal of lymph nodes.”

Prior to surgery, women participating in the clinical trial are given an injection of dye in the breast, which travels to the armpit. “Only the nodes that pick up the dye, the sentinel nodes, are removed and tested,” Dr. Kong said. “If the nodes are positive for cancer, the patient is then randomized as to whether she will have all her lymph nodes removed, which is the standard of care, or receive radiation therapy only to the armpit.”

“I was placed in the group to have all lymph nodes removed,” Mandy said. “But it was important to me to participate. Cancer treatment can be invasive, and I wanted to be part of an effort to change that. You can’t make changes without data, and I was very happy to provide data to help advance breast cancer treatment.”

Recovery

After surgery, Mandy followed up with radiation therapy, administered by radiation oncologist Carmen Bergom, MD.

“Because her lymph nodes were positive, she has a higher risk of a local recurrence of cancer in the chest wall and lymph nodes,” Dr. Bergom said. “Radiation therapy helps reduce that risk.”

With the support of her husband, Matt, and her mother, who drove her to and from her appointments, Mandy weathered the long months of treatment and recovery. Today, this mother of two is doing well, working full time and taking good care of herself.

“Honestly, I feel better today than I ever have in my life,” she said. “I feel I’m healthier. I pay attention to what I eat, and I try to exercise every day. Those two things have kept me very strong and grounded.”

What’s more, Mandy’s experience has made her keenly interested in genetic research, and she makes a point of following the latest advances. “It’s important to me to know that in the coming years, genetic studies will change the way cancer is treated.”