Innovating Ovarian Cancer Diagnostics, with Nicole Sandford, CEO of Aspira Women’s Health

[00:00:00] [SPEAKER_01]: My first couple of weeks I just couldn't believe I had the opportunity to do what I was doing.

[00:00:07] [SPEAKER_01]: We all kind of dream of the day that you can take the job, that you really feel like you were put on the earth to do

[00:00:13] [SPEAKER_01]: and that you really feel is making a difference. I've had some great opportunities over the course of my career but nothing like this.

[00:00:21] [SPEAKER_00]: This is Overlookt and I'm Golda Arthur. In this podcast we believe women's health can't wait

[00:00:27] [SPEAKER_00]: were already decades behind in research. So it's always interesting for me to talk to people trying to move that need a long

[00:00:35] [SPEAKER_00]: faster. My guest today is Nicole Sandford, the CEO of a company called Aspira Women's Health.

[00:00:45] [SPEAKER_00]: Aspira develops diagnostic tests for gynecologic diseases like ovarian cancer,

[00:00:51] [SPEAKER_00]: their blood tests, screen women who have masses on their ovaries and they're working on other

[00:00:57] [SPEAKER_00]: kinds of tests as well, including one for endometriosis. Nicole is also a cancer survivor

[00:01:03] [SPEAKER_00]: and she talks about how that informs her leadership of Aspira. Here's Nicole Sandford.

[00:01:12] [SPEAKER_00]: Hi Nicole, thanks so much for joining us on Overlookt.

[00:01:15] [SPEAKER_00]: My pleasure, thanks for having me. Tell me about Aspira Women's Health and what you guys do.

[00:01:22] [SPEAKER_01]: Sure, so we are a bio analytical company. We offer non-indvasive tests for gynecologic

[00:01:29] [SPEAKER_01]: disease and are currently commercially available tests are focused on helping physicians identify

[00:01:37] [SPEAKER_00]: ovarian cancer in women with innexal masses. Let's unpack that a little bit more. What is an

[00:01:51] [SPEAKER_01]: ADNExal mouse? What is it? That's a mouse that's in or around the ovary.

[00:01:56] [SPEAKER_00]: It can be assuming that that is a generic term for something that could be assessed or something else.

[00:02:04] [SPEAKER_01]: That's right, it can be a variety of things. Ovarian cancer is relatively rare

[00:02:08] [SPEAKER_01]: about 20,000 women a year. Our diagnosis with ovarian cancer but more than a million women will

[00:02:15] [SPEAKER_01]: have a nexal mouse diagnosed. The good news is the odds of a mouse being ovarian cancer is small.

[00:02:25] [SPEAKER_01]: Not so great news is that the things that are benign and not concerning in any way

[00:02:30] [SPEAKER_01]: look an awful lot like the things that you should be worried about on ultrasound and that makes it

[00:02:36] [SPEAKER_01]: very difficult to identify patients that have something that they need to address with surgery

[00:02:43] [SPEAKER_01]: or with a consultation with another physician versus something that can be watched and will

[00:02:50] [SPEAKER_00]: result itself. If you told me five years ago that I would enjoy conversations about the ovarias as much

[00:02:55] [SPEAKER_00]: as I do, I would have left in your face but I miss my own ovarian squared a lot. I do as well.

[00:03:04] [SPEAKER_00]: We will talk about that as well coming up. Let's start here walk away through the products

[00:03:10] [SPEAKER_01]: that you guys make. Sure, so we offer blood tests. A very simple test that can be drawn in a doctor's

[00:03:19] [SPEAKER_01]: office or in a laboratory setting and sent to our lab where we will analyze biomarkers

[00:03:27] [SPEAKER_01]: protein biomarkers primarily and run that with various biometric information, age,

[00:03:33] [SPEAKER_01]: and pauses that as for example against an advanced algorithm that has been trained to identify

[00:03:40] [SPEAKER_01]: masses that are at a higher or lower risk for ovarian cancer. Who are these products for?

[00:03:47] [SPEAKER_01]: Who is really your target audience here? We offer the tests primarily through gynecologists

[00:03:54] [SPEAKER_01]: but also primary care doctors, nurse practitioners in a variety of different settings.

[00:03:59] [SPEAKER_01]: So any woman who is diagnosed with a mass is the right patient for one of our tests. We have

[00:04:07] [SPEAKER_01]: a variety of indications but they were all created to help identify ovarian cancer risk in women with masses.

[00:04:16] [SPEAKER_00]: And I know that you are currently working on outreach to clinicians.

[00:04:22] [SPEAKER_00]: So tell me a little bit more about the kind of outreach that you're doing.

[00:04:25] [SPEAKER_01]: So the primary way that we that we reach physicians is through our so ourselves for

[00:04:32] [SPEAKER_01]: for both in the terms of the field team and our insights helps team but we also do a fair amount

[00:04:38] [SPEAKER_01]: of outreach through through publications and conferences. But you know we're working really hard to

[00:04:45] [SPEAKER_01]: drive this as the new standard of care for any woman with a mass. If I could pivot for a second

[00:04:51] [SPEAKER_00]: to ask about your own story, one thing you and I have in common weirdly is that we've both

[00:04:59] [SPEAKER_00]: had had an ovarectomy. Mine was quite recently when was yours?

[00:05:04] [SPEAKER_01]: 2021. So you know about six maybe six months or so before they came the CEO of the Spira

[00:05:10] [SPEAKER_01]: actually. Tell me that story Nicole? I mean the outcome is the same for all of us. The story just

[00:05:18] [SPEAKER_01]: seems to be completely different. It's a meandering story like it is for all of us. My journey really

[00:05:23] [SPEAKER_01]: started when I was diagnosed with breast cancer in 2016 and I took to Moxafin as a lot of women do

[00:05:35] [SPEAKER_01]: after breast cancer diagnosis and it does do some strange things to your uterus and I have that

[00:05:43] [SPEAKER_01]: situation. So you know at one point long after my misfectumase and reconstruction, oh when I should

[00:05:50] [SPEAKER_01]: mention also I did lose my grandmother on my dad's side long before I was even born to ovarian

[00:05:56] [SPEAKER_01]: cancer. So I do have that sort of family history although I don't have a genetic predisposition

[00:06:02] [SPEAKER_01]: based on the genes that we know today right so I'm not I'm not bracket I don't have sort of a

[00:06:07] [SPEAKER_01]: known genetic linkage but for all those reasons I'm considered high risk. So as I was discussing

[00:06:14] [SPEAKER_01]: options and what I wanted to do about some of the things that I was dealing with for my uterus,

[00:06:21] [SPEAKER_01]: they identified a mass an an excellent mass on my ovary. Again this is before our Overwatch

[00:06:27] [SPEAKER_01]: test was available. I did ask the doctor to run an over one test prior to the surgery because I

[00:06:33] [SPEAKER_01]: wanted to understand the risk that we were looking at a potential malignancy and the risk was very low

[00:06:39] [SPEAKER_01]: but that that was a surgical triage tool. Our new tests would be used even before that

[00:06:44] [SPEAKER_01]: decision point to say should you even be going and removing the ovary at all or the or the

[00:06:50] [SPEAKER_01]: mass at all. My doctor did remove my ovaries at that time and I was immediately put into surgical

[00:06:58] [SPEAKER_01]: menopause which has been probably the biggest surprise and I don't mean that in a good way

[00:07:05] [SPEAKER_01]: of my life is the symptoms were so much worse than I had anticipated and they don't seem to really

[00:07:12] [SPEAKER_01]: get better. When does this stuff start to go away? I can't find a lot of quality research that

[00:07:18] [SPEAKER_01]: helps the answer that question and menopause just as a general statement is completely under research.

[00:07:25] [SPEAKER_01]: So you know it has been a real a real journey for me and I feel like I'm managing the symptoms

[00:07:30] [SPEAKER_00]: better now but it's still very challenging. Oh yeah, to know it's completely kicking my ass right now.

[00:07:39] [SPEAKER_00]: Yeah, well said. I'm curious about this how does this personal experience of yours?

[00:07:50] [SPEAKER_00]: How does that inform your work as someone who leads a women's health care company?

[00:07:57] [SPEAKER_01]: Like does or does it inform you? Oh it absolutely does. I mean that I'm in the fight primarily

[00:08:03] [SPEAKER_01]: to help avoid the kind of situation that you and I are going through.

[00:08:07] [SPEAKER_01]: Look, I'm never going to say you know if you're at high risk and you have a mask that's high

[00:08:12] [SPEAKER_01]: risk and our tests is validates that of course you should have a surgical intervention and

[00:08:18] [SPEAKER_01]: if that also means removal of the ovaries. Of course that makes sense in in in some cases but given

[00:08:25] [SPEAKER_01]: the low incidence of ovarian cancer and the number of oofrectamies that are done in this

[00:08:32] [SPEAKER_01]: country, which is about 200,000 or more actually just our recent study that was a much higher number.

[00:08:40] [SPEAKER_01]: But you know at least 200,000 surgical interventions removal of ovaries and women with a 20,000

[00:08:48] [SPEAKER_01]: patient population for cancer, that that seems to me like we're taking a lot of healthy ovaries

[00:08:54] [SPEAKER_01]: that that could stay in place and you know we're learning more and more every year we're learning

[00:09:00] [SPEAKER_01]: that keeping your ovaries for as long as possible improves your overall long-term health as a woman

[00:09:07] [SPEAKER_01]: which seems obvious but is not then an obvious conversation. So yeah my personal experience weighs

[00:09:14] [SPEAKER_01]: very heavily on on my day to day oversight of the company and sort of just drive to never give up

[00:09:22] [SPEAKER_01]: I mean we're just not going to give up this test matters a lot and I think the encouraging part

[00:09:28] [SPEAKER_01]: is I have two daughters in their 20s. They don't they don't take anybody's word for anything when it

[00:09:34] [SPEAKER_01]: comes to health. I mean they will do the research right and you know that's not always high quality

[00:09:40] [SPEAKER_01]: information you get if you're just relying on Dr. Google but you can actually get a lot of really

[00:09:46] [SPEAKER_01]: good information now about studies and new technologies and new products that just weren't available

[00:09:52] [SPEAKER_01]: to our mothers and to some extent to us so I'm encouraged to see women in their 20s and 30s who are

[00:10:01] [SPEAKER_01]: you know asking more questions before they just kind of go in and have a surgery that's going

[00:10:06] [SPEAKER_00]: to change the rest of their lives. Yeah and I you know I do feel there is this heavily like this

[00:10:14] [SPEAKER_00]: dependence on the skew towards surgery as the solution for everything isn't there. They're absolutely

[00:10:21] [SPEAKER_01]: is and he what's interesting too is in our country I think in the United States surgical intervention

[00:10:29] [SPEAKER_01]: is more heavily favored than in other parts of the world but that doesn't seem to be resulting in

[00:10:35] [SPEAKER_01]: earlier diagnosis of a variant cancer. In fact, will the variant cancer coalition or they publish

[00:10:40] [SPEAKER_01]: to study and survey that showed that we were the slowest among the developed countries in the survey

[00:10:46] [SPEAKER_01]: from the time a women experienced experiences symptoms to the time that they were diagnosed

[00:10:51] [SPEAKER_01]: with a variant cancer was more than 20 weeks as long as any developed country so you could say

[00:10:57] [SPEAKER_01]: that you know are default to surgical diagnosis doesn't appear to actually help us to find

[00:11:04] [SPEAKER_01]: certain ovarian cancer faster. Now we do a pretty good job treating women once they're they're

[00:11:09] [SPEAKER_01]: diagnosed but but we need to do better in that time from from symptoms which by the way most women do

[00:11:16] [SPEAKER_01]: experience symptoms which is a real fallacy around a variant cancer so you know another another

[00:11:21] [SPEAKER_01]: message to people listening is listen to your bodies and if something doesn't feel right keep asking

[00:11:26] [SPEAKER_01]: questions until you get an answer as to what's going on. Yeah yeah the keep asking questions

[00:11:33] [SPEAKER_01]: that is so important I think. Yeah I think it's important part of what we're trying to do is

[00:11:40] [SPEAKER_01]: insert a more objective data into the discussion and get away from making decisions about your

[00:11:47] [SPEAKER_01]: body based just on fear you know we can find ovarian cancer sooner and we can

[00:11:54] [SPEAKER_01]: triage the right people to the right doctors at the right time if we open our minds to new

[00:12:00] [SPEAKER_01]: technology and and look in fairness to doctors because I'm certainly not here to bash doctors

[00:12:04] [SPEAKER_01]: by any stretch of the imagination there was very little innovation that happened in diagnosis

[00:12:10] [SPEAKER_01]: of gyneclogic cancers overall but in in a very cancer in particular in the last probably 30 or

[00:12:16] [SPEAKER_01]: 40 years I mean CA 125 is a biomarker that a lot of doctors use but they're using it in a

[00:12:22] [SPEAKER_01]: lot of cases off label it really was only recommended and only labeled for use as recurrence monitoring

[00:12:28] [SPEAKER_01]: tool and a lot of women don't know that but you'll have an elevated or an abnormal I guess result

[00:12:34] [SPEAKER_01]: for CA 125 for a lot of reasons and absolutely have nothing to do with ovarian cancer

[00:12:39] [SPEAKER_01]: and so it leads you down a path but that was all that was available but you know now I think we all

[00:12:46] [SPEAKER_01]: owe it to patients and to each other and and to you know our our daughters frankly to you know

[00:12:54] [SPEAKER_00]: keep the minds more open than in the past I'm very curious about this broadly across the board

[00:13:00] [SPEAKER_00]: everyone that I talk to has thoughts on this and I'm curious what your thoughts are I want to do

[00:13:06] [SPEAKER_00]: an episode at some point called how to talk so your doctor listens which is a provocative

[00:13:12] [SPEAKER_00]: title because obviously it doesn't matter how you talk your doctor should be listening to you

[00:13:16] [SPEAKER_00]: regardless right but you know the ideas to provoke a discussion on it and if I had to put that to you

[00:13:24] [SPEAKER_00]: as a prompt how to talk to your doctor listens so your doctor listens well what would you say how

[00:13:29] [SPEAKER_00]: should what should women do with those 10 minutes that I'd given in the doctor's offices

[00:13:33] [SPEAKER_01]: Jesus that's a tough one I will say that I knew something was wrong before I was diagnosed with

[00:13:41] [SPEAKER_01]: breast cancer and I had laudular cancer which is it's not really easy to find on your own it's

[00:13:48] [SPEAKER_01]: not it doesn't present to the lump that you feel in the shower anything like that it's more like

[00:13:52] [SPEAKER_01]: string so it wasn't that I felt something but something just felt off and I went to my doctor

[00:13:58] [SPEAKER_01]: and you know my blood work showed while your vitamins D levels very very low like and I said well

[00:14:05] [SPEAKER_01]: I'm tired but that's not it like there's something else there and you know he to his credit

[00:14:13] [SPEAKER_01]: did listen this was just my GP this wasn't my gynecologist and he said you know hey if you haven't

[00:14:18] [SPEAKER_01]: been back to your vannicologist and while he'd better pop over there and you know see see the

[00:14:24] [SPEAKER_01]: see get your annual physical there so I did go maybe maybe a month later but you know I just

[00:14:30] [SPEAKER_01]: had the confidence and I've always been a little bit of a rabble rouse or anyway so it's not

[00:14:34] [SPEAKER_01]: a big stretch for me to just be like yeah I don't think that's it I don't doubt that my vitamin D

[00:14:41] [SPEAKER_01]: is low but something else is wrong right and so you know I do think it's just a matter of following

[00:14:48] [SPEAKER_01]: your gut and understanding your body and it's important I think when you're first meeting with a

[00:14:54] [SPEAKER_01]: doctor to get a good sense of that somebody that'll listen to you so it's not a this is a good

[00:15:01] [SPEAKER_01]: doctor that's a bad doctor you're a good patient or a bad patient it's like any other relationship

[00:15:06] [SPEAKER_01]: if it doesn't feel like you're comfortable opening up and and you know exploring what you're talking

[00:15:13] [SPEAKER_01]: about until you're satisfied then you probably need to try someone else and you have that

[00:15:17] [SPEAKER_01]: little voice in your head for a reason and if that little voice is telling you I'm not done

[00:15:21] [SPEAKER_01]: asking questions and I'm feeling dismissed then just find somebody else yeah um Nicole you seem like a

[00:15:29] [SPEAKER_00]: real fighter if you can't it yes so let me let me ask you this what's the dream here what's the dream

[00:15:36] [SPEAKER_00]: scenario for the the products that a spiral has you know well first and foremost I need women to go out

[00:15:44] [SPEAKER_01]: and buy stocks in companies like a spiral we need to take responsibility for funding this work

[00:15:52] [SPEAKER_01]: I should tell you that the very first interaction I had with a spiral I bought stock I took

[00:15:58] [SPEAKER_01]: it took some money I had in my IRA and I called my broker and said put $x dollars which was a

[00:16:04] [SPEAKER_01]: pretty significant number for me but by no stretch of the imagination didn't make me a large investor

[00:16:09] [SPEAKER_01]: but I said I believe in this company I believe in this test and I want to invest if every woman

[00:16:17] [SPEAKER_01]: who has an IRA somewhere did that not just for a spiral but there are other women's health companies

[00:16:24] [SPEAKER_01]: that that really we need to be we need to feel a heck of a lot more responsible for the capital

[00:16:31] [SPEAKER_01]: infusions that are necessary for these tests and these technologies so let me first say that's the

[00:16:37] [SPEAKER_01]: that I look around and a room for my shareholders and see more women because there's very few

[00:16:44] [SPEAKER_01]: and that's kind of sad frankly that's number one but I think that the technology that we've

[00:16:51] [SPEAKER_01]: developed with you know and and our partners in the development are very prestigious

[00:16:57] [SPEAKER_01]: academic and research institutions like Dana Farber and Johns Hopkins University these are really

[00:17:04] [SPEAKER_01]: advanced high-performing tests that we have here we can use that same technology in other

[00:17:09] [SPEAKER_01]: gynecologic diseases I frankly would love to see now we're working on a test for endometriosis

[00:17:14] [SPEAKER_01]: we've completed the design of the very first blood test that identifies endometriosis

[00:17:21] [SPEAKER_01]: at high primarily endometriomas but there's no reason to believe that a similar approach wouldn't

[00:17:28] [SPEAKER_01]: work for other gynecologic diseases and we need that we need companies like a spiral to continue

[00:17:34] [SPEAKER_01]: to be able to innovate on gynecologic disease diagnostics because it's been

[00:17:40] [SPEAKER_01]: willfully underinvested in for many many years as you know overlooked

[00:17:47] [SPEAKER_00]: and Jane so many so many interpretations of that and overlooked is a mild way to put it

[00:17:53] [SPEAKER_00]: in so many ways so what is the challenge like among the challenges that you have spread out in

[00:17:59] [SPEAKER_00]: front of you keeping you from that dream those dreams and areas what's the biggest one?

[00:18:06] [SPEAKER_01]: I just think operating in the United States in the healthcare system the way it's designed right now

[00:18:12] [SPEAKER_01]: is really impossible for for most companies that are innovating it's not just an aspiring problem

[00:18:21] [SPEAKER_01]: it's a system-wide problem I was very excited to see the research

[00:18:27] [SPEAKER_01]: allocations that President Biden proved earlier this year that's exciting but we have rock solid

[00:18:34] [SPEAKER_01]: research so that's not really the problem for a company like mine right we just need to recognize

[00:18:40] [SPEAKER_01]: that you know we need better incentives for for insurance companies and doctors to innovate

[00:18:47] [SPEAKER_01]: and to take advantage of the of the new technology so that's probably the thing that

[00:18:53] [SPEAKER_01]: that keeps me up at night we could do everything right but if the system is broken

[00:18:58] [SPEAKER_01]: to a point where it can't support a company like ours you know women are going to suffer

[00:19:05] [SPEAKER_01]: we can't really as women we can't afford to wait anymore we must get more active in fixing

[00:19:11] [SPEAKER_00]: at once and for all right in fact that's the tagline of the of the podcast women's health

[00:19:16] [SPEAKER_01]: can't wait that's right absolutely that's true