WASHINGTON — Karen Handel, the Republican trying to win a Georgia congressional seat Tuesday in the most expensive House race in U.S. history, has been haunted throughout the election by her past with Dallas' Susan G. Komen for the Cure foundation.

Five years ago, Handel was at the center of a Komen controversy when the cancer prevention foundation briefly halted its donations to Planned Parenthood for breast exams — a decision that would saddle the high-profile nonprofit with a public relations nightmare.

The controversy led to Handel stepping down while boosting her anti-abortion credentials, but cost Komen millions in donations and a lasting tarnish on its brand.

Karen Handel, Republican candidate for Georgia's 6th Congressional District, greeted diners Monday during a campaign stop at Old Hickory House in Tucker, Ga. The race between Handel and Democrat Jon Ossoff is seen as a significant political test for the Trump administration. (David Goldman / The Associated Press)

The issue has re-emerged in the Georgia House race, where Handel is battling Democrat Jon Ossoff for the seat vacated by Health and Human Services Secretary Tom Price.

The contest is widely seen as a bellwether for President Donald Trump and the GOP's popularity ahead of next year's midterm elections, and the candidates and outside groups have spent nearly $50 million in an effort to woo voters, according to multiple news reports.

In attack ads and debates, Ossoff has accused Handel of engineering the Planned Parenthood decision for political gain, leaving the former Komen executive to explain, once again, her role in the debacle.

The decision

Handel had served as Komen’s vice president of public policy for less than a year when the organization moved to suspend funds to Planned Parenthood, a decision made public in early 2012.

Komen officials initially offered varying explanations for the move to pull roughly $700,000 to the group, including a change in grant-making policies to prohibit funds to organizations under investigation by government officials. At the time, a House Republican was investigating whether Planned Parenthood used federal dollars for abortion services, a violation of the law.

Given Handel's history of opposing Planned Parenthood, pointedly declaring herself an opponent of the organization during her failed 2010 run for Georgia governor, many blamed her for the decision to pull the breast cancer screening funds from a major women's health provider.

Planned Parenthood does not typically conduct mammograms, but performs hundreds of thousands of breast health exams annually.

The backlash

The fallout was predictably swift and painful for the Dallas-based nonprofit begun by former ambassador Nancy Brinker in honor of her sister. Critics accused Komen, and Handel, in particular, of politicizing the organization and thus betraying its core mission.

Robert Passikoff, president of brand loyalty research group Brand Keys, said Komen was until then widely seen as a “safe brand with broad appeal” and enjoyed “universal good will.”

The Planned Parenthood episode engulfed the Komen foundation in controversy. (2012 File Photo / Rex C. Curry)

But "you lose good will the minute that you become embroiled in anything that has the sense of political," he said.

Though many cheered Komen for the move, countless angry consumers blasted the decision. Komen reversed course within three days, and Handel soon resigned, calling Planned Parenthood a "gigantic bully."

Komen quickly moved into damage control — and remained there for months.

"We let you down, and for that, I'm profoundly sorry," Brinker said in the aftermath of the controversy. "No explanation will ever fully allay the anger, hurt and disappointment, but I can only tell you that our motivations were and our intentions were, as they've always been, centered on trying to help women."

In June 2013, Dr. Judy Salerno replaced Brinker as Komen’s CEO. Brinker served as Komen’s chair of global strategy until moving into a volunteer role in 2015.

Brinker and Komen did not respond to multiple calls and emails for comment. A spokeswoman for Handel pointed to a "fact check" on her campaign website about the issue, noting it was the Komen board — not Handel— that made the decision.

The climate

The move came at a particularly crucial time in the Texas abortion debate, recalls Mark Jones, a political scientist at Rice University. In 2011, the Texas Legislature voted to cut two-thirds of funding to family planning programs in a bid to stop taxpayer dollars flowing to clinics that perform abortions.

After several family planning clinics closed, the Legislature restored much of the money two years later.

“The decision by Komen to stop grants to Planned Parenthood fit in very well with the broader political message in Texas Republican circles that Planned Parenthood used funding obtained from other sources to perform abortions,” Jones said.

Planned Parenthood, like Komen, has insisted the funding is only used for breast health screenings.

The fallout

The damage to Komen was multilayered and long-lasting. Several executives resigned. Its popularity plummeted in an annual poll of leading charities. Registrations at its charity events declined. And it cost Komen tens of millions in donations.

The organization took in $348 million in contributions, sponsorships and race entry fees in the fiscal year ending in March 2012, but just $270 million a year later, in the wake of the controversy, financial documents show. Komen officials have acknowledged the Planned Parenthood issue was part of the drop in funds, but also cited the economic downturn.

Contributions continued to decline through 2015, but there are signs of a rebound: After dipping to $201 million that year, the nonprofit garnered $211 million in contributions in fiscal year 2016.

Jones doesn't believe Komen felt the backlash as intensely from Texans as it did supporters from across the nation. "Where it hurt them the most was among conservatives, who probably didn't realize there even existed any connection to Planned Parenthood," he said.

Though Komen took a walloping, the scandal may have helped Handel's conservative bona fides. She published a book in 2012 called Planned Bullyhood: The Truth Behind the Headlines about the Planned Parenthood Funding Battle with Susan G. Komen for the Cure.

While Handel has maintained it was the Komen board’s decision, and not hers, to cut ties with Planned Parenthood, she appeared to take more ownership of the move in a recent debate against Ossoff.

"I led the effort to find a way to have those dollars that were going to an organization that did not even provide mammograms, cannot legally provide mammograms, be reinvested," she said earlier this month, according to the Atlanta Journal-Constitution.

Komen, for its part, has continued to defend the decision.

In a 2015 interview with The Dallas Morning News, Salerno, who stepped down from the organization last year, said the money addresses critical issues of access and affordability for low-income or uninsured women.

“Breast cancer is not a political issue,” Salerno said.