Revolutionizing Women's Health: Insights from Aspira's CEO
We are pleased to present this month’s episode of Leadership Reimagined, featuring Nicole Sandford, CEO and board member of Aspira Women’s Health. Join us for an inspiring conversation to discover how Aspira is transforming women’s gynecological health with the discovery, development, and commercialization of innovative testing options for women of all races and ethnicities, starting with ovarian cancer. In this episode, which is particularly poignant during National Women’s Health Month, Nicole shares, ” Women’s health care is underfunded. That has been probably the most frustrating part of all is to have a technology that works better than anything we’ve ever had in a disease that kills women and to still be searching for fundamental investors who are willing to invest for the long term.” Don’t miss this insightful discussion on leadership, innovation, resilience, and passion!
Nicole was appointed to the Board of Aspira Women’s Health (NASDAQ:AWH) in February 2021 and has served as President and Chief Executive Officer since March 2022. Nicole spent over 27 years with Deloitte, starting her career there as an auditor specializing in high-growth global companies in the technology, healthcare, and industrial sectors. Nicole is a member of the Advisory Board for Ellig Group, an Emeritus Member of the Weinberg Center at the University of Delaware, and the patient representative for the Greenwich Hospital Breast Cancer Accreditation Committee. She was previously the Board Chair of Girl Scouts of Connecticut and a Board Member of the Stamford Public Education Foundation.
Please enjoy this episode of Leadership Reimagined featuring Nicole Sandford, CEO and board member of Aspira Women’s Health!
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Janice Ellig
Welcome to Leadership Reimagined, where game-changing conversations are reshaping the world of work. I’m Janice Ellig, CEO and founder of Ellig Group, Executive Search Advisors, pioneers in redefining executive search through our unwavering commitment to diversity, equity, and inclusion. Today on Leadership Reimagined, our topic is Revolutionizing Women’s Health: Insights from Aspira CEO, and I’m delighted to welcome Nicole Sandford, CEO, and board member at Aspira Women’s Health.
Prior to joining Aspira, Nicole was a global board services leader at Ellig Group, and I was very happy to have her here. Prior to that, she spent 27-plus years with the global consultancy firm Deloitte, launching and leading all aspects of operations for multiple businesses. In her last role as US Managing Partner, Deloitte Risk and Financial Advisory LLP’s Regulatory and Operational Risk Business, she led a major team. Previously, she was a Deloitte and Touche LLP audit partner, specializing in high-growth global companies in the technology, healthcare, and industrial sectors. She’s the past board chair of Girl Scouts of Connecticut and on other major, not-for-profit boards. Nicole has received the Yale School of Management’s Rising Star Award and the International Alliance for World of Difference 100 award. I am so delighted, Nicole, to welcome you to today’s podcast and to welcome you back to Ellig Group.
Nicole Sandford
Thank you, Janice. You’ve been a wonderful mentor to me for many, many years, so it’s a true honor to be a guest on the podcast today. Thank you for having me.
Janice Ellig
I was there in many sessions that you had at Deloitte when you were building out corporate governance and working with so many companies. You have quite an impressive background, with your Deloitte career and now at Aspira and the impact that you made at Ellig Group. I want to go back on your career journey, which is not the most common for a CEO. Tell us a bit about how you got to that CEO seat and how your experiences in the past have prepared you to be the CEO of a woman’s health care organization.
Nicole Sandford
Yes, I’ve had a little bit of a winding road, a little unique path. I started, as you mentioned, as an auditor at Deloitte, but I was always willing to take on new assignments and go in different directions, and over time, I found that I had a real knack for starting or turning around businesses. I love doing that. I had incredible opportunities at Deloitte to really stretch myself and go in different directions. In probably about 2019 or so, I decided that I was ready to go out and try some new things and joined Ellig Group to lead the board practice, which was incredible.
I also was looking for my first board role myself. At that time, I was already a shareholder of Aspira. I learned about Aspira Women’s Health when I participated in a panel discussion at the Yale School of Management with my predecessor. We were talking about resilience, and she was talking about this incredible blood test that was available for assessing malignancy risk in adnexal masses. That really piqued my interest. Not only am I a breast cancer survivor, and therefore automatically at higher risk for ovarian cancer, but I also lost my grandmother to ovarian cancer. As a mother of two daughters who are walking around with some genetic predispositions, I was very interested in this blood test. I went back and did some research and realized that the science was incredibly sound and that this test was, frankly, overdue to become the standard of care. Bought some shares of the AWH stocks, started to follow the company, and was subsequently invited to join the audit committee as the chair, which was a perfect fit with both my passion and my background at Deloitte.
Fast-forward a little bit after that, while I was still working with you as a matter of fact, the CEO role was offered to me when my predecessor decided to retire. I didn’t have to think too long about whether I wanted to lead the company, for all the reasons I just mentioned. But looking back at the experiences that I had at Deloitte and then working with Ellig Group and your clients, I felt like I had been really training for this role my whole career. Working with great companies and also with companies that are turning things around, working with boards and senior leadership teams to align around strategy was practice for this role. All the things that we got to do together in the board practice really helped to prepare me.
Janice Ellig
It did, Nicole. You had exceptional experiences, but now you’re in the number one seat of a publicly traded company. I want to talk a little bit about Aspira’s business and what you’re trying to do. But first, in those two years that you’ve been in that seat, what are some of the takeaways, what you’ve learned as being the number one in charge of a publicly traded company?
Nicole Sandford
I don’t think you ever stop learning when you’re the CEO. I’ve always said that my success has been more than 50%, probably the majority, fueled by having great people around me, both in terms of my executive team and the employees of the company. One of the things that I did as soon as I arrived at Aspira was I took a really critical look at the team that we had and really wanted to understand if we needed to make any changes. I believe, and I’ve always believed, that if someone is in the wrong role or with the wrong company, you’re not doing them any favors by continuing to have them on the team. It is a much more ethical thing to do, to have an honest conversation about what they might be doing differently, either within the company or somewhere else. That’s not a wonderful part of the job, frankly, but it’s important to have the backbone to do those things.
What you find is when you do upgrade the talent or when you do make tough decisions, the high-performing people in the company respond, and they put their shoulder into it, and they see that you’re willing to make the hard choices. Keeping people engaged, inspired, and really behind the mission, that’s what it’s all about. If you have the right people in the company, and they’re excited and passionate about what you do, your job as the CEO is definitely going to be a lot easier.
Now, having said that it has been a really challenging market for biotech companies and for diagnostic companies overall. We all know. We read the same articles. Women’s health care is underfunded. That has been probably the most frustrating part of all, is to have a technology that works better than anything we’ve ever had in a disease that kills women and to still be searching for fundamental investors who are willing to invest for the long term. That’s a little bit frustrating, but we’re never giving up. I’m certainly never giving up. As long as the technology keeps evolving, we have what we need.
Janice Ellig
There are many listeners here who may want to be one buying your stock, investing in you. Tell us about Aspira’s OvaSuite portfolio of products and how they’re revolutionizing women’s health care.
Nicole Sandford
I like to say that Aspira was developing AI-powered tests before anybody really understood what AI-powered meant. Now, it’s obviously the sexy catchphrase, but going all the way back to the early 2000s, we had licensed technology from Johns Hopkins University and built it into a really powerful algorithm. With a simple blood test, we can assess the risk of malignancy for any woman who has an adnexal mass. For those of you who don’t know, an adnexal mass is a mass that’s either on or in the ovary. In most cases, it’s a sign that absolutely nothing’s wrong. Most of these masses are benign and non-cancerous. You wouldn’t even know they were there if you didn’t have an image of it.
But women, rightfully so, worry when they see a mass. Maybe they know somebody who had ovarian cancer. We all know that when it’s caught late, it’s quite deadly. But when it’s caught early, it’s not. The default may have been, “Let’s go ahead and take out the ovaries” always, but that’s not healthy for women. Long-term, you want to keep your ovaries. It doesn’t matter how old you are, you want to keep your ovaries for your whole life if they’re healthy and if your risk is acceptable. We have multiple tests, but we call it OvaSuite, because we have a test for every single mass, every woman who presents with a mass to the doctor. It will, with a simple blood test, run an AI-powered algorithm to tell the doctor, “What is the risk that this mass is a malignancy?” If you’re going to surgery, that’s important because you want a gynecologic oncologist to do that surgery. They’re specially trained to remove malignancies, which can be accidentally ruptured by an untrained doctor who’s doing a hysterectomy or a nephrectomy.
If you’re not going to surgery, and you’ve decided to take a watchful waiting approach because you and your clinician both believe the risk of malignancy is low, then you can preserve your ovaries. That is a huge deal. In fact, there was just an article in the Wall Street Journal about the importance of ovaries for long-term health, in terms of heart disease risk. Now, there are some linkages to potential dementia, Parkinson’s, and a whole host of things that we’re now finding that women who have their ovaries removed and stop producing estrogen are at higher risk of experiencing. What we, as a company, are committed to doing is continuing to develop non-invasive risk assessment tests. But we already have commercially available tests that are the best in the world at this, and we’re going to keep driving those to be the standard of care. But we’re going to also continue to develop the most effective blood tests, non-invasive tests, for identifying malignancy risk and both find cancer earlier and preserve ovaries whenever possible.
Janice Ellig
Nicole, what is the message to women, men, everyone out there, and to doctors in terms of should this test be administered as part of a regular checkup every two years, every year? What’s the protocol here?
Nicole Sandford
Our tests are not screening tests. They’re for symptomatic patients, so they wouldn’t be something that you just automatically have when you go see the doctor. They are for women who have been diagnosed with an adnexal mass, which impacts well north of a million women a year. 1.2 – 1.5 million is a solid estimate as to the number of women who will be diagnosed with an adnexal mass. So it’s not a screen, but if you do have a mass there is a risk assessment test for you. One of the most damaging myths about ovarian cancer is that it’s a silent killer and there are no symptoms. The World Ovarian Cancer Coalition does a fabulous study around the world, and their research says there are symptoms. The challenge is the symptoms are very similar to other things.
The first message to women, and to anybody who loves a woman who has her ovaries, is don’t ignore your symptoms. If something feels wrong, push to have an ultrasound and see what’s going on. Then if there’s a mass present, push to have a test like our OvaSuite tests performed so that you can make a decision based on data and facts and not fear. A lack of effective diagnostic tools has led women to make a lot of decisions about their bodies and their reproductive organs based on fear; better safe than sorry. But that has not translated into faster diagnosis or better outcomes, so it doesn’t work. We need to do things differently, and that includes taking advantage of technology like the OvaSuite tests.
Janice Ellig
Is this an education of the physicians?
Nicole Sandford
All of the above. It’s the physicians, it’s the payers, it’s the patients. All of us have to be willing to look at new technologies. Our tests for ovarian cancer are a great example, but there are others as well, and gynecologists, maybe because they tend to be a little bit more risk-averse, potentially have been slower to adopt some of the newer technologies in the gynecologic disease space. We want to get to a point where people are as willing to stay on top of and understand the risk and what can be done from a diagnostic perspective for all gynecologic diseases and women’s health issues, and not just breast cancer. We’ve made so much wonderful progress in breast cancer.
Janice Ellig
You’ve said in past interviews that we need a radical change in how we address women’s health. Is this all part of it? Are there other things that can be done? What is Aspira doing in terms of this radical change?
Nicole Sandford
There’s so much to do. I’m very pleased with the recent changes that we’ve seen at the federal level. I’ll start with the federal, but there have been some interesting developments at the state level, as well – to fund additional research for women’s health. That’s broadly referring to both diseases that only affect people who were born female or born with female reproductive organs and diseases that affect that population differently. It’s not just about gynecologic disease or female reproductive disease, it’s also about things that affect us differently. We saw the Biden administration allocate about a hundred million dollars of new research dollars to women’s health, which was revolutionary, and they’re moving quickly, also. ARPA-H, which is the agency overseeing the granting of those funds, is moving pretty quickly to get that money allocated to women’s health research, which is phenomenal.
At the state level, we’re seeing lots of different biomarker testing bills being put forward. A dozen or so states have passed laws saying that, in their state, they would like to make sure that all insurers, commercial and otherwise, are paying for biomarker tests for all different kinds of diseases, including cancer. Delaware passed a law specific to ovarian cancer coverage, which is wonderful, but there are some that are broader than that, not just for ovarian cancer, but for other diseases. I love to see the momentum.
There’s so much more to do because a really difficult part of being a small company with innovative technology is the lift that’s involved in getting paid by commercial insurers. Commercial insurers that have Medicare Advantage plans have to pay for our tests because Medicare has reviewed our technology and decided that it’s medically necessary. It’s on their fee schedule, so Medicare patients get the test paid for. But the same commercial insurance company can look at another beneficiary of another plan and say it’s not necessary or it’s experimental, which is, to me, a little bit crazy. We need to see that end of the problem fixed, not just for Aspira, but for all innovative technologies. You can’t go to 70 different insurers and convince them one at a time with different information and different data requirements. It’s not feasible. I love to see the research, but we need to fix the other end as well.
Janice Ellig
The payers have to be consistent in terms of if it’s being covered by one such as Medicare for your tests, it should be covered by all.
Nicole Sandford
Exactly.
Janice Ellig
Otherwise, women’s health is at risk, again, by unnecessary surgeries or not making it a simple procedure for a cure. Much more has to be done. You mentioned this earlier. You have a personal connection with Aspira from your own experiences. I’m wondering, does it make a difference? I’ve spoken to other CEOs of other organizations. Some really feel personally committed and invested. It seems like you really have this on a very personal front, to what you’re doing in leading a company, in terms of being really purposeful because you’ve had that experience.
Nicole Sandford
I would agree with that. Let’s be honest, I was really happy doing what I was doing with you. I wasn’t out there looking to become the CEO of anything, much less a biotechnology company like Aspira. The passion for the mission and the desire to make sure that this technology becomes the standard of care for all women drives me.
I should mention also, there’s another diversity aspect here that a lot of people don’t know. But ovarian cancer is an even bigger problem for many ethnic groups. Women of color face different types of cancer that are sometimes harder to spot. They’re diagnosed later, their fatality rates are higher, and one thing that I noticed recently, in some of the data I was looking at, is ovarian cancer rates for white women in the US have actually been trending downward for many, many years. We still have a lot of work to do, don’t get me wrong, but it has been coming down a little bit.
There’s been no movement at all in other ethnic groups such as Black women and Hispanic women. There’s no change in their survival rates over time or their cases or survival rates, which is partially because they’re even less likely to be diagnosed using the traditional method of ultrasound, MRI, and some biomarker tests that were approved for other uses. This is a diversity issue, not just in terms of people born female, but it’s also a huge diversity issue for women of color. As you know, I have always been passionate about diversity. It’s been my number one cause. Since I was able to have a voice and use it, I’ve been using it for an enhanced understanding of how diversity drives better business outcomes. For me, it was the coming together of so many things I care about that brought me here.
Janice Ellig
Nicole, knowing you for all these years, as I do from your Deloitte days, you are passionate about whatever you’re doing, and it is a position when you take that on, you are gung ho. You’re going to make a difference. You did that at Ellig Group because when you joined me after being 27-plus years at Deloitte – I said, “Would you run the board advisory and search practice?” And you said, “Absolutely.” But you also said, “We need to get more women and underrepresented groups into the boardroom,” as well as the C-suite. You started the Ellig Group Board Readiness Coaching Program, in which today, 28 executives have completed the program, and over 70% are on a board. You made a great difference, in terms of preparing people for that next executive role in the boardroom. Tell us a little bit about why you were so passionate about that, why you said we must do it, and you made that happen.
Nicole Sandford
First of all, it couldn’t have happened anywhere other than Ellig Group, and the team that you had when I came in was already really well-positioned to do the things that we were talking about doing. So first and foremost, all the credit in the world goes to you, Janice, for building such a great team and for being willing to do things differently and to invest in something that we both believed was important but had never been done before, frankly.
The board program, when I would talk to strong candidates about joining boards. Both of us did a lot of, I’ll call it free consulting with people when they were looking for a board, their first board, especially women and other diverse groups. That was wonderful, but they often left those calls feeling a little bit overwhelmed. They didn’t really have the resources to do the things we were telling them to do in terms of building your network, fixing your bio, do some specific targeting. It’s ironic. You’re talking to people who have always had a team of people, or at least in the recent past, had a team of people do things. Now, they’re out looking for themselves and they don’t have a team of people behind them to support them and help them. So being arms and legs that can do those kinds of things for them was a big innovation of the program.
Beyond that, it can be lonely. Looking for your first board, it’s a process. It takes time, and it’s a little bit lonely. It’s easy to be someone who has been successful and maybe hasn’t been turned down for anything for a really long time, and now, you might have to interview for a dozen boards before you find the right fit. There’s a piece of it that’s just creating a safe place and a safe network. We also encourage people in the program, and I’m sure that you’re doing this even more now, if you get a call for a board that you are not interested in, know the other people in the program and who might be a good fit and share those opportunities. There’s a lot of different elements to it. That’s just a little preview. But it was really about making it a lot less painful and more pleasant, frankly, and that has made a big difference.
Janice Ellig
It is true. It is this really strong network, and we reach out to those individuals who’ve gone through and are now on a board for the people we’re now putting through this six-month program. They’ve been so helpful. As you know, we also acquired Maggie Wilderotter’s Board Academy Bootcamp, which is a day and a half. We have the six-month program, the day-and-a-half program, but it’s all to really make sure people can be empowered to be in charge of their destiny, to get on that board and be confident about what they can offer. You’ve done so much in this area.
I also applaud you for what you did during your 27 years at Deloitte because you were the expert in corporate governance, and you started the Center for Corporate Governance. You were the founding member. From your time there, what did you see, in terms of why greater diversity on boards was important, from that perch, that perspective, as a consultant at Deloitte?
Nicole Sandford
The program that we developed at Deloitte was a very high-level advisory and strategic consulting practice. We were dealing with the very highest level of the organization, the CEO and the board. I think I worked with over a hundred companies when I was in that role, in various capacities. I started to see some patterns emerge and realized that although there were exceptions, I was often called in to help a company in two completely different situations. One was a great board and a great executive team that was highly functional, and they wanted to make sure they stayed that way. They would work with our team to ensure that they were constantly looking for best practices. They were constantly upping their game. The other extreme is we were often brought in on the other side of a crisis or some other dysfunctional situation. I didn’t need to do a ton of research to notice that the boards that were great and wanted to stay that way were often more diverse than the boards that were in a crisis or digging their way out of a problem.
It’s nice that we now have so much empirical evidence, in surveys and studies, that shows that is the case, but I didn’t really need all that research. I could see it with my own eyes. That was one of the reasons why. I’m just a very practical, pragmatic person. If I could see something that just seemed to be so obviously different from one to the other, introducing that as an alternative to the boards that needed diversity was an easy sell, in my mind, because I was confident it would make a difference.
That was where this all came from. Our chair at the time was Sharon Allen, who was the first female chair of any large professional services firm and an incredible leader and mentor. I worked with her to launch that board diversity program at a time when I could tell you for sure, it wasn’t a foregone conclusion that it was going to be a success. You were there from the beginning, Janice, as you mentioned before. This is something that you have also been passionate about for a long time. I suspect, for the same reason, that you could see the impact in your day-to-day, as well.
Janice Ellig
It just makes sense that if a company is serving employees, customers, communities, and shareholders, and I put it in that order, you have to reflect those constituents. That means a diverse population and diverse boardroom, and diverse C-suite. With women’s health, you’re making a major difference here, now. What is next for Aspira and what are your hopes for women’s health care going forward?
Nicole Sandford
I am super excited about the products that we have in development at Aspira. We have the next generation of our ovarian cancer risk assessment test. We’re collaborating with the Dana-Farber Cancer Institute to layer in some additional data points, including microRNA biomarkers and clinical data that we think is going to produce an even more effective test for assessing malignancy risk for women with masses and has the potential to completely eliminate unnecessary surgery for women who have masses on or in their ovaries, which is exciting.
We’re also looking to pivot that technology to other gynecologic diseases. In particular, we’ve been developing a test for endometriosis, which is extremely devastating. There are close to 6 million women, or some estimates, even more than 6 million women, in the US alone who suffer from endometriosis. It’s something that keeps them from going to work or school. It’s something that costs them tons of money. They are misdiagnosed and gaslighted. They spend their whole teen years in horrible pain, being told that it’s not real. The only way to identify it now is through a laparoscopic procedure. You can imagine, if you have a 12- or a 13-year-old girl who you think has endometriosis, and the only way to know for sure is to go do an invasive look, you’re going to probably wait a little while to do that, for lots of reasons.
Having tests available to identify endometriosis through a blood test is a big deal. And we have published data for the first time. We have developed a protein-based test that is highly effective at identifying endometrioma, which is the most common form of endometriosis and is also in the form of a mass on the ovary. We’re looking for partners to help us to launch that test and drive adoption of it globally. We also are using the same microRNA technology that we are working with for the ovarian cancer tests to layer that into what we’ve already learned with the protein biomarkers and intend to launch an endometriosis test that uses that technology, as well. Very exciting advancements.
But we have a lot of work to do on the other side of even those tests because I believe, based on what my data scientists can see in the data, that this technology may very well work for other gynecologic diseases and gynecologic cancers. This is a really, really important company for anyone who cares about women’s health to take a look at and consider making sure that it’s in your portfolio because we need women to be invested. Janice, I’ll tell you, it is ironic. I have wonderful shareholders who have been long-term shareholders in the company. None of them are women, which I find really hard to believe, but that’s a fact. I need more women to go invest in companies like Aspira to make sure that we can get the job done.
Janice Ellig
That’s not a good statistic.
Nicole Sandford
No, it is not a good statistic.
Janice Ellig
It’s a serious message, I think, to everybody who’s listening that for the health, wellbeing of women, but also families and society.
Nicole Sandford
That’s right.
Janice Ellig
We have to invest. We must fund organizations such as you so that you can continue the great work you’re doing with minimal invasive testing to find ways of therapies that’ll be really great for women at all ages.
Nicole Sandford
That’s right.
Janice Ellig
And that payers will see that this should be covered because what’s worse is not to be preventative and women then go in the hospitals. It increases healthcare costs when it can be done with a simple blood test. Any parting words for our audience on what to look forward to?
Nicole Sandford
My parting words are, again, I appreciate the opportunity to be with you today. It’s a real honor for me. Any day that I get to talk about Aspira and what we’re doing is a good day, so I appreciate that and look forward to continuing to work with you and the advisory board at Ellig Group to keep driving change at the board level.
Janice Ellig
Yes. I’m so pleased that you’re on my advisory board, so you didn’t quite leave me. You’re still with me, which I totally value.
Nicole Sandford
No, I’m not going anywhere.
Janice Ellig
Nicole Sandford, you have been a force at Deloitte, at Ellig Group, and now at Aspira Women’s Health. You are revolutionizing it. We do need that radical change to take place, but you are positively impacting women’s health. I, for one, am going to invest some more in your company. I hope others will, as well. Please continue to speak out on LinkedIn, because that’s a great way of getting your message across.
Nicole Sandford
Thank you. I always say what I think, so that’s not likely to change, either. But thank you, Janice.
Janice Ellig
Nicole Sanford, thank you so much again for joining us today and leading the way as CEO, and board member of Aspira Women’s Healthcare and making all of our lives better as we go into these future years. Thank you to our audience for tuning into another game-changing conversation on Leadership Reimagined. You can find me on LinkedIn and Instagram, or visit our website at ElligGroup.com. Thank you to Nicole Sanford, for joining us, and to our audience.
