The $400 Test That Could Save Your Life (If Insurance Would Cover It)
How biotech entrepreneur Sheila Mikhail went from building billion-dollar companies to fighting for basic screening rights
The radiologist pulled Sheila Mikhail into a separate room after her biopsy results came back positive. He wanted to show her something on the mammogram from her initial screening—the one that had missed the tumor they'd just found.
"See, it's not my fault," he said, pointing to the image. "See, there's nothing there."
Sheila stared at the screen. She'd just been diagnosed with bilateral breast cancer—tumors totaling six centimeters that had been growing undetected despite annual mammograms at one of North Carolina's top medical institutions. And this radiologist wanted her to know it wasn't his fault.
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"That didn't make me feel any better," Sheila tells me during our conversation for Kicking Cancer's Ass. "I felt like I was in a horror show. Nobody knew what they were doing."
But somebody did know. The system was working exactly as designed—for some women, just not for the 50% who have dense breast tissue.
The $4 Billion Company Builder Who Couldn't Get a $400 Test
Sheila wasn't supposed to be a cancer patient. As co-founder of AskBio, which Bayer acquired for over $4 billion, she'd spent her career developing treatments for rare diseases affecting children. At 56, she was thin, healthy, exercised regularly, didn't smoke or drink, and had no family history of breast cancer.
"I was always told that I was at low risk for getting breast cancer," she says. "I went every year like most women to get my mammogram. I was always assured that I didn't need to worry about it."
The 3D tomosynthesis mammograms, she was told repeatedly, were "incredible" and "meant for people like you that had heterogeneously dense breasts." If she had "extremely dense breasts," then they'd be concerned. But most women have dense breasts, and she just had "a little bit dense."
This language matters. It's the difference between vigilance and complacency, between early detection and advanced disease, between a lumpectomy and a double mastectomy.
When Sheila found that small indentation in November 2022—just months after a clear mammogram—and insisted on additional screening, she faced the medical gaslighting that thousands of women with dense breasts encounter:
"It's not the standard of care"
"Insurance isn't gonna pay for it"
"It's gonna cost you $1,200"
"You're starting to really create a ruckus"
That last comment came from her oncologist. Sheila's response was immediate: "It's my life."
She paid the $1,200 out of pocket. The additional screening found an even larger tumor on the other side.
The Economics of Denial
Here's what makes the insurance industry's resistance to covering supplemental screening so infuriating: the math is overwhelming in favor of coverage.
Medicaid in North Carolina covers supplemental screening for women with dense tissue because they did the economic analysis. The cost difference between stage 2 and stage 3 diagnosis? Over $100,000 per patient, and that's from older studies—current costs are likely much higher.
An abbreviated breast MRI costs around $400. A breast ultrasound costs $150-180. Compare that to the cascade of costs from later-stage diagnosis:
Multiple rounds of chemotherapy
More extensive surgery (often double mastectomy vs. lumpectomy)
Multiple reconstruction surgeries
Extended time out of work
Higher bankruptcy rates
Devastating impact on families
"Earlier stage diagnosis means less treatment costs," Sheila says. "Pretty common sense."
But it's not just about treatment costs. Later-stage diagnosis has a higher likelihood that a woman never returns to work. Women are often primary caregivers, so advanced cancer affects children, families, and entire communities.
"If you have a stage one diagnosis, it's almost a hundred percent curable," Sheila notes. "If you have a stage four diagnosis at the other end of the spectrum, there is a 75% chance you won't be here in five years."
For a few hundred dollars.
Want to learn more about Breast Cancer Screening - Revisit Episode 3 with Dr. Harriet Barofsky
The Screening Lottery
The evidence against mammograms alone for dense tissue is now "unequivocal," as Sheila puts it. Studies show that up to 50% of tumors are missed in women with dense tissue. The recent BRAID study and numerous other trials have demonstrated that supplemental screening finds significantly more cancers.
Sheila uses a stark analogy: "Would you get on a plane if you knew that TSA missed 50% of bombs? You would not. Yet women are expected to get these 3D mammograms and be satisfied with it."
The comparison to enhanced screening is dramatic:
Ultrasound: Finds 2-3 additional tumors per 1,000 women screened
Breast MRI or contrast-enhanced mammography: Finds 12-14 missed tumors per 1,000 women screened
"If I had to do it over, I would've asked for a breast MRI," Sheila says. "And that's what I do now in my surveillance. Every six months I go and I make sure I get one of those two."
The Geographic Lottery
Currently, 37 states mandate insurance coverage for supplemental screening in women with dense tissue. Thirteen states—including North Carolina—do not.
The result? A stunning paper compared medical practices between North Carolina and New Jersey after both states implemented breast density notification laws. In North Carolina, women were primarily referred for 3D mammograms (the same test that had already failed to detect cancer). In New Jersey, women were referred for breast MRIs.
The difference? Insurance coverage.
"Insurance coverage really dictates medical practices," Sheila observes, "not science."
The Betrayal of Trust
Perhaps the most devastating aspect of Sheila's story isn't the medical failure—it's the betrayal of trust. She did everything she was supposed to do. She showed up annually for screening. She followed her doctors' advice. She trusted the system.
"I still feel, and many women like me, I've met many women who, like me, showed up for our mammograms, relied on the advice of our doctors from top medical institutions. We feel really betrayed because they took away our ability, our right to have an earlier diagnosis."
The system made decisions for her by withholding information about additional screening options. Instead of saying, "There's this additional test, it may cost you a few hundred dollars. Would you be willing to invest in that?", they simply assured her that mammograms were sufficient.
"They took that option away," she says. "We were treated like we don't have the right to spend our money in order to make sure that our health is okay."
Creating a Ruckus
When Sheila went back to Duke after her treatment and asked how they could make screening better for other women, she was told it was her fault for not demanding supplemental screening from the beginning. Even after getting cancer and fighting for appropriate screening, she was blamed for not knowing what she didn't know how to ask for.
That's when she decided to create a real ruckus.
BC Ruckus was born from that oncologist's comment, and Sheila has been making noise ever since. She's fighting for the Save More Tatas Act in North Carolina (named because male legislators told her not to use the word "breast" because it made them uncomfortable) and the federal Find It Early Act.
The resistance comes primarily from insurance lobbying groups who think supplemental screening is "too expensive." This from an industry that profits billions while women die from preventable late-stage diagnoses.
The Transformation
Cancer changed Sheila in profound ways. After building companies for over 20 years, she had to step down as CEO during her 66 radiation treatments. The woman who once ran a 1,000-person company operating in five countries now has zero tolerance for corporate nonsense.
"I don't put up with BS as much as I used to," she says. "You become very cognizant of the fact that there's only so many grains in the hourglass."
But the change goes deeper than impatience with inefficiency. "I focus more on today and now," she reflects. "I spend a lot more time appreciating everything that's around me and really being immersed in the feelings and the environment and just being more conscious and aware of all the good things that are here now."
She's also clear about what matters: "Every time my mind starts racing about recurrence or even death, I just keep bringing it back, like, Hey, right now it's happy and it's good, and let's see all the good things."
The Fight Continues
Sheila's not just fighting for supplemental screening—she's fighting for the principle that women deserve accurate information about their options. The burden shouldn't be on patients to know what they don't know how to ask for.
"Even after women are educated and they know they need supplemental screening, they get so much pushback," she notes. "So they really have to have all the facts in hand and they have to be really armed and insistent on it."
Her message to women is uncompromising: "If your doctor says you're creating a ruckus, create a ruckus and save your life."
What You Can Do Right Now
Know your breast density. Federal law now requires this information on mammogram reports. Look for it.
Ask specific questions. Don't ask for "supplemental screening"—ask specifically for breast MRI or contrast-enhanced mammography if you have dense tissue.
Don't accept "3D mammograms are fine." They're not fine for dense tissue. The research is clear.
Pay out of pocket if necessary. $400 for an abbreviated MRI could save your life and prevent $100,000+ in treatment costs.
Contact your representatives. Support the Find It Early Act to mandate insurance coverage.
Educate other women. Share information about dense breast screening. Print flyers from mydensitymatters.org or densebreast-info.com.
The Bigger Picture
Sheila's story illuminates a fundamental problem in American healthcare: insurance companies making medical decisions based on profit rather than science. While 37 states have seen the light, 13 more need to join them.
"37 states have seen the light. 13 more to go and it will change," Sheila says with characteristic determination. "There's so much information coming out now, so many studies being done. It's overwhelming evidence that women with dense tissue need supplemental screening."
The evidence is overwhelming. The economics are clear. The technology exists. What we need now is the political will to prioritize women's lives over insurance company profits.
As Sheila puts it: "It's life and death. And a few hundred dollars to give a woman a better chance at life seems to me like a pretty good economic investment."
Time to create a ruckus.
Resources for Action and Education:
Educational Resources:
My Density Matters: mydensitymatters.org
Dense Breast Info: densebreast-info.com
BC Ruckus: bcruckus.org
Legislative Action:
Find It Early Act: Contact your House representatives and senators
Save More Tatas Act: North Carolina residents contact state legislators
Advocacy Organizations:
Liz Powell's Breast Cancer Screening Advocacy lobbying effort
Partnership organizations working with BC Ruckus for federal legislation
Remember: Your health is worth fighting for. Sometimes, the most important thing you can do is refuse to be polite about saving your own life.