Battling rare breast cancer, Manheim Township woman gets married, nears doctorate degree

Shannon Strohl knew something was amiss. The Manheim Township woman suspected breast cancer when she felt a lump, but her primary care physician wasn't quite sure. Strohl was only 29 and breast cancer is found in women 45 and older in 90% of newly-diagnosed cases, according to the American Cancer Society.

Then over the course of weeks in July and August 2023, Strohl's left breast swelled and the skin texture changed.

Through her insistence over multiple doctor's visits, Strohl was scheduled for an ultrasound and mammogram.

"The mammogram actually got denied by my insurance company initially because of my age," Strohl said. "Then during the ultrasound they're like, 'You're getting a mammogram.' It was looking bleak at that point."

Strohl soon learned it may have looked much worse had that appointment come any later.

The journey that started after the appointment has led Strohl to share her experience. Today she urges others to push for answers if they feel something may be wrong with their health. She also encourages a reassessment of work-life balance due to her suspicion that working too hard too long led her to a dangerous place.

'Chronically done too much' A biopsy of the lump in Strohl's left breast confirmed she had inflammatory breast cancer, which accounts for just 1% to 5% of all breast cancers, according to the American Cancer Society.

"Sometimes the patients are so young they would not have been screened through mammograms," said Dr. Abby Geletzke, a Lancaster-based breast surgeon for University of Pittsburgh Medical Center. "So we are completely relying on women's self-examination to let us know that something is wrong. The cancer can spread so quickly. It can go from just a very faint redness to some scaly skin change to a mass and a large portion of the breast and lymph node involvement in not very much time at all."

It's why Strohl began chemotherapy shortly after her diagnosis Sept. 21, 2023, and why she couldn't put the treatment on hold for her wedding just weeks later.

"I went for chemo the next day (after the wedding)," she said. "I wasn't missing chemo unless someone pried me away and told me that I can't."

Strohl, a Lehigh County native, works as a licensed counselor for a Lancaster-based counseling service. She has already obtained bachelor's in psychology from Moravian University and master's degree in clinical mental health counseling from Kutztown University and is on track to finish a doctorate degree in counselor education and supervision from Duquesne University by the end of this year, all by age 30.

Part of that schooling with Duquesne, located in Pittsburgh, involved travel back and forth from Lancaster for a year.

"I was driving to Pittsburgh and flying to Pittsburgh and doing all kinds of crazy things," she said. "In my mind I do wonder if that's why I got cancer ... I have chronically done too much. During my treatment I intentionally slowed down."

At the same time, she approached her cancer battle with the same aggressiveness as she did her schooling, according to mother Connie Zellner and sister Stephanie Stermer, both Lehigh County residents.

"She was determined to get it started so she could get this behind her," Zellner said.

"She is the exact same person as she was before she found out," Stermer said. "It didn't change her attitude."

Strohl's 75-year-old maternal grandmother has also been fighting a different form of breast cancer over the same span, though Strohl underwent testing that revealed no genetic component or link to her rare form of inflammatory breast cancer.

"A lot of women who will have a breast cancer diagnosis won't have a strong family history of it," Geletzke said.

Weekly rounds of chemotherapy at UPMC Lititz in Warwick Township from Oct. 9, 2023, through March 5 shrunk the cancerous lump in Strohl's left breast, as well as cancerous lymph nodes in her left armpit. Next came the removal of those masses through surgery, and along with it a weighty decision for Strohl.

'Betrayed' Side effects from chemotherapy for Strohl included neuropathy (tingling in her fingers), nausea and diarrhea. Steroids to offset those side effects caused weight gain.

"The biggest thing was vision," she said. "I would get ocular migraines sometimes."

Strohl's hair fell out almost immediately after she began chemo in October 2023, resulting in Stermer leading a fundraiser to purchase a $4,000 wig for Strohl that looks nearly identical to her natural hair.

"Throughout my life I have associated hair with my identity, my personality," Strohl said of wearing a wig. "I do it for myself but I also do it to avoid questions, people looking at me, feeling uncomfortable."

Strohl wore the wig during her wedding Nov. 5, 2023, which came just six days after her fourth round of chemotherapy.

"I felt good that day," she said. "I wasn't sure if I would."

Strohl had two options when it came time for surgery to remove the shrunken, cancerous masses.

READ: Sisterhood of the 'traveling bag of hats': Lancaster County cancer patients help each other cope

READ: Hempfield teacher keeps a positive outlook as she battles breast cancer, urges women to get mammograms

READ: 'I needed to be on that field': Hempfield girls lacrosse coach talks about breast cancer fight

READ: Manheim Township woman shares what she's learned from 9-year breast cancer battle

READ: 'I knew there was hope': Former Conestoga Valley teacher, coach Gina Novak shares breast cancer journey

READ: Thrivers breast cancer support group unites Lancaster County real estate agents

One was to remove just the left breast, called a mastectomy, and several lymph nodes on her left side.

The other option included the removal of lymph nodes and both breasts - called a double mastectomy - and with it the chances of the cancer coming back to appear in her right breast.

"Both breasts are gone," she said. "If one was going I didn't want to just have one breast."

She also felt her body "betrayed" her already with cancer in her left breast and didn't want to take the risk of it returning in right breast.

Geletzke performed the surgery on Strohl on April 17.

"That (surgery) involves removing the breast tissue, the overlying skin and the lymph nodes that sit under the arm," Geletzke said. "And removing all of the lymph nodes that sit just outside the pec muscle and just underneath the pec muscle, under the arm."

Strohl is still getting used to her new appearance without breasts.

"I felt more of an attachment to my hair than my breasts," she said. "The biggest thing is more so with the weight gain feeling like I'm uneven. I'm thicker in my stomach but then I don't have anything on my chest. That's the part that's an adjustment for me."

Strohl could opt for breast reconstruction surgery in the future, but it would come with challenges given the removal of so much tissue during the double mastectomy.

'Strong and graceful' "When plastic surgeons do reconstruction sometimes they can use something called a tissue expander," Geletzke said. "The expander is a hollow breast implant that is filled with fluid slowly over time to stretch that tissue."

But because so much tissue was taken from Strohl, the tissue expanders won't be an option. She'd instead have to get fat and blood vessels cut from the wall of her lower belly and moved up to her chest to rebuild the breast, a surgery referred to medically as a deep inferior epigastric perforator flap.

Strohl said she might pursue that option. Meanwhile, she's still recovering from what came after the double mastectomy and lymph node removal: 30 rounds of daily radiation treatment - Monday through Friday - at the Proton Therapy Center inside Penn Medicine's Ann B. Barshinger Cancer Institute in East Hempfield Township.

The radiation killed any potential cancer cells still lingering in her body. She completed the last round of radiation on July 25.

"Shannon has been so brave and strong and graceful through all of this," Geletzke said. "I am nothing short of completely impressed with how she went through this. ... She really inspires me."

As Strohl puts cancer behind her and focuses more on the career path ahead, she is aiming to do so while keeping in mind the lessons learned over the last year or so.

'Old habits die hard' In her profession, Strohl said she primarily counsels adults and some teens 14 and up.

"I have a background in substance use and addiction counseling," she said. "There are some clients I have who are in recovery or are currently dealing with substance abuse problems. Primarily now I deal more with mental health, life adjustment, life stuff with clients."

As she gets back to her life without cancer, she is fighting the temptation to return to pushing herself to the brink, like she did in the lead-up to her diagnosis.

"Old habits die hard," she said. "My overall goal is to work less. I will get to that, it's just that I have to invest some time in the next couple months to years, and then my hope is to be able to do less."

Another hope is that by sharing her journey it will ultimately save lives by raising awareness on inflammatory breast cancer.

"With breast cancer, we have this important message of encouraging women to go get mammograms," she said. "But there are some cancers like mine where you don't know ... I originally got denied by my insurance of getting a mammogram because I was so young. So push for imaging."

Her experience has already helped at least one person: a male friend similar in age who was recently diagnosed with testicular cancer.

"We had the hindsight of my situation, and I said to him, 'If your doctor says it's no big deal, push for imagining,'" Strohl said. "That's literally exactly what happened. He's getting chemo now."