Cancer, Courage, and Changing Oklahoma Law With Melissa Provenzano
Episode Summary
Oklahoma State Representative Melissa Provenzano joins David Raubach for a candid, deeply personal conversation about the collision of cancer, courage, and legislative action. Provenzano, a former high school principal who entered politics in 2018 after Oklahoma’s historic teacher walkout, shares how a constituent’s financial crisis — forced to choose between a $1,200 diagnostic mammogram and feeding her children — became the seed for House Bill 1389, landmark legislation requiring insurance companies to cover diagnostic breast cancer screenings at no out-of-pocket cost to patients.
The episode traces the arc of two legislative victories separated by three years. In 2022, Provenzano successfully passed the original diagnostic mammography coverage bill, making Oklahoma the 10th state to mandate such coverage. By 2025, gaps in coverage for newer imaging technologies — contrast-enhanced mammograms, molecular breast imaging, and other advanced modalities — prompted a significant expansion effort. This second bill sailed through both chambers but was unexpectedly vetoed by the governor, who cited concerns about rising insurance rates. The veto, Provenzano argues, was not only medically indefensible given data from other states but ironically created a wave of statewide awareness that ultimately made the override stronger and more unified than a quiet bill signing ever could have.
Running the expansion bill in 2025 while simultaneously navigating her own breast cancer diagnosis gave the episode a rare and raw dimension. Provenzano learned in November that she had a fast-moving, aggressive form of breast cancer — discovered during a mammogram delayed from September because she was campaigning for re-election. By December 11th she had completed screening, a biopsy, an MRI, and an ultrasound. Surgery (a single mastectomy) followed in January, chemotherapy began in February, and by late March — as her hair began falling out — her bill was moving to the House floor. She made the difficult decision to go public with her diagnosis, a choice she describes as the best she ever made, as colleagues and strangers across Oklahoma poured out stories of their own losses and diagnoses.
The veto override itself became a defining legislative moment. Senator Brenda Stanley, the Republican Senate author whose husband had spent $4 million fighting stage four prostate cancer before dying, presented the override with what Provenzano describes as “fire coming out of her fingertips.” Multiple female senators rose to share their own stories. Most memorably, Republican Senator Bergstrom — who had voted against the bill — announced he would support the override because, after returning home from the Capitol, his wife and daughters had corrected his thinking. Out of more than 60 gubernatorial vetoes that session, the legislature overrode approximately 47, with HB 1389 clearing both chambers. The bill takes effect November 1st of the same year.
Beyond the legislative narrative, Provenzano and Raubach explore the broader cancer landscape in Oklahoma — a state with higher-than-average breast cancer incidence rates and some of the worst cancer mortality rankings in the country, including a 50th-place ranking for certain cancer types. They connect Oklahoma’s mortality crisis directly to screening access, discuss the financial toxicity of even early-stage cancer (Provenzano’s own early-detection surgery cost $44,000, with chemotherapy running $7,000 per treatment), and look ahead to the next frontier: lowering the standard mammogram access age from 40 toward 30, expanding genetic testing coverage, and protecting Sooner Care recipients from looming federal Medicaid cuts.
What You’ll Learn in This Episode
- House Bill 1389: Oklahoma legislation requiring insurance companies to cover diagnostic breast cancer screenings — including advanced imaging — at zero out-of-pocket cost to patients, effective November 1, 2025.
- Diagnostic Mammogram vs. Screening Mammogram: A screening mammogram is a routine check; a diagnostic mammogram is ordered when something is found and may include ultrasound, MRI, contrast-enhanced mammogram, or other modalities — the type that was previously unaffordable for many Oklahoma women.
- Contrast-Enhanced Mammogram: One of the advanced imaging technologies added to Oklahoma’s coverage mandate by the 2025 expansion, allowing detection of cancers that standard mammography can miss.
- The 10th State Milestone: When the original 2022 bill passed, Oklahoma became the 10th state in the country to require insurance coverage of diagnostic mammograms, a benchmark achieved through partnership with the KMAN Foundation and organizations like Oklahoma Project Woman and the Stone Brook Project.
- Financial Toxicity of Cancer: Even with early detection, Representative Provenzano’s single mastectomy cost $44,000, chemotherapy ran $7,000 per treatment, port removal was $4,000, and ongoing Herceptin injections add thousands more — illustrating why screening access is an economic justice issue, not just a medical one.
- Oklahoma’s Cancer Mortality Crisis: Oklahoma ranks among the worst states in the country for cancer mortality — 50th for certain cancer types — with higher-than-national-average breast cancer incidence rates, a gap that early screening access is designed to close.
- Veto Override Dynamics: Oklahoma’s governor vetoed HB 1389 citing insurance rate concerns, but the legislature overrode the veto — one of approximately 47 overrides out of 60-plus vetoes in that session — after statewide media coverage created enormous public pressure and a rare moment of bipartisan unity.
- Going Public with a Diagnosis: Provenzano agonized over disclosing her own breast cancer diagnosis while sponsoring a breast cancer bill, fearing it would look self-serving. She ultimately went public in late March, when hair loss from chemotherapy would have made it impossible to hide — and describes the decision as one of the most powerful of her career.
- HER2-Positive, Fast-Moving Cancer: Provenzano’s cancer was hormone-receptor negative and HER2-positive — an aggressive subtype — caught at a very small size (4–5 mm in diameter) because of timely mammography, demonstrating the life-saving value of the very policy she was championing.
- Herceptin (Trastuzumab) Subcutaneous Injection: After completing chemotherapy, Provenzano transitioned to a newer subcutaneous formulation of Herceptin (trastuzumab), administered once every three weeks as a shot instead of an IV infusion — eliminating the need for her port and illustrating rapid advances in cancer treatment delivery.
- Bipartisan Cancer Advocacy: In one of Oklahoma’s most partisan legislative environments, HB 1389 succeeded by transcending party lines — Republican Senate author Senator Brenda Stanley, House Speaker Charles McCall (whose wife had had breast cancer), and others joined a Democrat sponsor because personal cancer experience overrides political identity.
- Next Legislative Frontier: Provenzano and advocates are already looking ahead to lowering the standard mammogram access age from 40 toward 30, expanding insurance coverage of genetic (BRCA-type) testing, and protecting Oklahoma Medicaid (Sooner Care) recipients from potential federal funding cuts that could leave uninsured cancer patients with no treatment options at all.
Representative Melissa Provenzano’s story is proof that the most powerful advocates are often those who have lived the injustice they are fighting to correct. From a constituent who couldn’t afford a $1,200 diagnostic mammogram, to a mother watching her own mom face cancer twice, to a legislator sitting in a chemo chair while simultaneously shepherding a landmark bill through a veto override — Provenzano’s journey is a masterclass in turning personal pain into public good. For anyone navigating a breast cancer diagnosis, fighting an insurance denial for a diagnostic scan, or simply wondering whether one person in a state legislature can make a difference, this episode is essential listening. Oklahoma is better — and women across the state are safer — because of her courage.
Full Transcript
Read Full Transcript
David Raubach: Thank you for joining us today on the Cancer Project podcast. We are really privileged to have State Representative Melissa Provenzano with us today. She has an incredible personal journey going through a cancer diagnosis just here recently. She’s also dealt with her mom going through not one but two different cancer diagnoses. And she was the sponsor of House Bill 1389, a bill here in Oklahoma which expands access for women needing diagnostic screening for breast cancer. Melissa, thank you for joining us today.
Melissa Provenzano: Thank you for having me on. This is an opportunity I’m so glad to have. When you asked, I’m like, “Oh, I’m there.”
David Raubach: Well, we appreciate your passion advocating for women who are needing screening for breast cancer. Just to kind of set the table a little bit — you joined the House of Representatives in 2018. Is that correct? What led to your interest in politics or wanting to get involved there?
Melissa Provenzano: So totally not in the same lane, but I was a high school principal and had been doing that for 10 years. In 2018 the teacher walkout happened here in Oklahoma, and so I drove down and met with my representative. He was a nice man, but I was tired of funding drying up. He was being termed out and the seat was open, so I decided to run. My husband and I figured out a way to do it and we’ve just been moving ever since. I have a relatively purple district and as a Democrat it was a lot of sweat equity, but hopefully bringing some balance to the capital.
David Raubach: I actually grew up in your district — in Tulsa. My parents still live in your district. Shout out to Shadow Mountain Estates and Memorial. What were some of the early focuses for you after you joined the legislature?
Melissa Provenzano: A lot of what I came to the role hoping to accomplish was centered around public education. But you also get a ton of ideas from knocking doors and talking to Democrats, Republicans, independents, libertarians. One of the pieces of legislation I was most proud of prior to the last few years was my work with the Demand Project, who fights child trafficking. We retooled the law to tighten up the language around that, helping police officers do their job better. Then in 2022, I actually ran the diagnostic mammography bill for the first time.
David Raubach: So what was the genesis of running that bill in 2022?
Melissa Provenzano: A constituent said, “I got my screening and they found something, so they ordered this next more expensive test, and then my insurance company would only pay a few hundred dollars for it. The rest was on me — about $1,200. And I had to decide between putting food on the table for my kids or doing this test.” So I reached out to KMAN at that time and they said, “Would you like to become the 10th state to require insurance companies to pay for diagnostic mammograms?” And yes, I would.
David Raubach: And KMAN is the largest organization, but not the only one. And you tapped into Oklahoma Project Woman as well as the Stone Brook Project.
Melissa Provenzano: Right. And then after that, we started having women say, “Hospitals are telling me it’s not covered; insurance companies are telling me it’s not covered.” So that’s when KMAN returned and said, “Would you please be willing to write an expansion of that law?” And so we did in 2025.
David Raubach: Oklahoma has historically been a state where it’s been difficult to get what some would call insurance mandates through the legislative process. What was it like getting the 2022 bill passed?
Melissa Provenzano: It was definitely a challenge, but KMAN and the Stone Brook Project were excellent partners. It was relatively easy to get through the House and the Senate. Insurance companies did push back and we tweaked the language to carve out high-deductible plans and out-of-state plans. I had a champion in Senator Brenda Stanley, who was the Senate author. Her husband had passed away from stage four prostate cancer, and they spent $4 million in treating him. So the argument that the bill would raise insurance rates didn’t really land with her. The governor signed it in 2022. When we ran the expansion in 2025, we were all stunned that he vetoed it.
David Raubach: For those not familiar with the nuances of the 2022 bill — what specifically did that bill require insurance companies to do?
Melissa Provenzano: That particular bill said if a doctor orders a diagnostic mammogram — and that could be an ultrasound, an MRI, or certain other modalities — the insurance company must pay for that with no out-of-pocket cost to the patient. The 2025 expansion added new machines: contrast-enhanced mammography and a couple of other newer technologies. So no matter where you were, what your zip code was, if you were a woman and your doctor ordered it, you got it.
David Raubach: I remember at the KMAN Pink Stiletto event they were talking about how much money had been saved by women since 2022. I think the total was over $1 million left in the pockets of women who didn’t have to pay for those screenings.
Melissa Provenzano: Yes, and now with the expansion and the higher profile of just the story of the bill, far more women — and men, because men can get breast cancer too — are aware. In 2022 women actually started getting refund checks because they had already paid that year. We expect the impact will be even larger this year.
David Raubach: I believe you won an award from the KMAN Foundation at the Pink Stiletto event. What award did you win?
Melissa Provenzano: Women of Influence. It was a lovely little pink heart statue. It was awesome. I got to speak and it was just an incredible night. I had my mom right by my side — and she very much avoids the limelight — but that night was incredible to be there.
David Raubach: You’ve been pretty transparent about the struggles that your mom has had with cancer — not just once, but twice. Tell us a little about her journey.
Melissa Provenzano: She was diagnosed for the second time this past October — 10 years after her first diagnosis. The first time it was caught very early; she had a lumpectomy and just had to do radiation. She felt like she got off easy. Then this past October, after I’d already agreed to run the expansion bill, it came back in the same spot. We were at Mario’s Pizza in Broken Arrow when she first told us. My mother is strength personified — a quiet queen — and for her to have to tell us something like that was profound. She opted for the full breast mastectomy. She was a patient care provider at St. Francis in Tulsa and helped people get their insurance bills paid by retooling the coding. She could navigate the system, but she still struggled. Can you imagine what the general population faces?
David Raubach: It’s a foreign language — when you look at an explanation of benefits, it’s just a bunch of very hard-to-decode information. So then your own diagnosis came as well?
Melissa Provenzano: Because of my mom, my sister and I were pretty religious about getting annual mammograms. I was due in September, but because I was campaigning for re-election it got pushed to November. In November it was caught — and it was so small we wondered if it even would have been caught in September. By December 11th I’d had the screening, the biopsy, the MRI, and the ultrasound. And when both my sister and I got genetic testing done, she didn’t pass us anything. My particular type of cancer was fast-moving and aggressive, so they moved fast and in an aggressive way to begin treatment.
David Raubach: That moment that you found out you had cancer — was it a phone call or did you get a report?
Melissa Provenzano: I knew the report was coming that day. My husband had gone to drop off his car to get new tires and something in my voice told him. This man who is 66 sprinted home. I found out at home, just kind of sitting with it. You go into shock and different people respond to shock in different ways. I just processed what is, and how do we cope and move forward — and then you want all the doctor’s appointments the next day. But it works at the speed of doctor availability. Navigating and picking a doctor, being told “we can’t see you for six months” when you don’t have six months to wait — I think most people struggle with that.
David Raubach: What was the most difficult part for you navigating those first few days or weeks?
Melissa Provenzano: Like every good Gen Xer, you turn to the internet to fill in the gaps until you see the doctor. You can convince yourself of a lot of things. Did it help? Did it make it worse? Yes — both. But I was thankful to get into the surgeon relatively quickly. He was a patient advocate about how do you want to go about this. I did catch it early. And my health insurance as a legislator — I’ll be very honest with you — is one of the best parts of the job. It felt like everyone should have the same access that I do.
David Raubach: I’ve seen you talk about the difficult decision to go public with your diagnosis — the concern that people might think running this bill while having breast cancer looked self-serving. How did you navigate that?
Melissa Provenzano: I had surgery in January — a single breast mastectomy — and chemo was due to start in February. By late March my hair was going to start to fall out, and you really can’t hide that. I had agreed to run the bill back in June or July when I ran into a KMAN representative at a conference — before any of this happened. And my treatment will have been much further down the line before this bill takes effect on November 1st, so it’s not going to benefit me directly. That was enough for me. But sharing my story — I’ll never forget the House floor leader, Representative Josh West. I told him I had this bill and if he was going to put it on the floor, could he please do it before I lost my hair. And that next Monday it was on the floor, and you turn around and just see little dots of pink everywhere. That was amazing.
Melissa Provenzano: After that were perhaps some of the most moving and powerful moments of my life. Everybody was looking somewhere to release their story. I heard about wives, aunts, sisters, best friends, mothers. I even had one staff person say, “I’ve just been diagnosed, but I haven’t told anybody.” People were looking for a place to put that. And those stories are going to stay with me for the rest of my life. I was a safe space, and I’m glad I did it — even though it was a lot for me.
David Raubach: I think having worked in the field of oncology for a couple of decades, one of the things you realize is that pretty much everybody has been impacted by cancer. I spoke at a high school a couple months back — I’m thinking these kids are 16, 17, 18, maybe they haven’t had this exposure. I asked the class who had a family member or friend who had gone through cancer. There were 30 kids in the class and 28 of them raised their hand. It doesn’t discriminate at any age.
Melissa Provenzano: When the governor vetoed it, he said insurance rates were going to rise. We had the evidence that in other states where this expansion existed, rates hadn’t increased at all. I had reached out and said if you’re even thinking about vetoing it, just let me come talk to you first. That didn’t happen. But the veto created this wave of awareness — I probably gave a hundred interviews. And in that veto message, the media bounce educated more women about the need. I think every single county in the state had a woman or a man calling their legislator saying, “We need this overturned.”
Melissa Provenzano: When it came time for the veto overrides, I went into an office to make my case, and the governor’s representative said, “Oh, House Bill 1389 — yeah, we’ve heard from everyone. You’re fine. We’re not going to fight it.” And then on the floor, Senator Stanley presented the override with fire coming out of her fingertips. Multiple female senators stood up and told their stories. Then Senator Bergstrom stood up and said, “I voted against this. I don’t believe in increasing insurance rates. But then I got home and my wife was waiting for me and took me to the woodshed. Then she turned me over to my daughters. I will be voting for this bill because I would like to go home.” It just stripped away party. We could do this all the time.
David Raubach: Talk a little about the party dynamic — Oklahoma is one of the most partisan states in the country, very red. Senator Stanley is a Republican. You were working primarily across the aisle. Was there hesitation?
Melissa Provenzano: There’s always that perceived discomfort of “am I going to work with a Democrat?” But Brenda doesn’t suffer a lot of that nonsense. She’s like, is it a good piece of legislation? Let’s go. She also lost her sister — not just her husband — to breast cancer. When I run legislation, I generally reach out to Republicans because you don’t get anything done by being rude. The first time around, House Speaker Charles McCall — his wife had had breast cancer. John Eckl’s mother had passed away from breast cancer. The letter behind your name didn’t change that. One in six women in Oklahoma is affected — more than the national average — and even just within the ranks of female legislators, everybody had a story.
David Raubach: Oklahoma has a higher incidence rate of breast cancer than the national average, and some of the worst cancer mortality rates of any state — literally 50th in certain cancer types. A lot of that has to do with screening. If we want to tackle cancer mortality in Oklahoma, we have to think about access to screening from the very beginning.
Melissa Provenzano: You know, women in Oklahoma can start getting a free screening once they’re 40. You can get one at 35, but just one, and you have to wait five years unless you have a family history. But you have younger and younger women being diagnosed. That’s kind of in my line of sight — what do we do to get that age of 40 down to 30? I have two stepdaughters and I’m like, I know we’re not genetically related, but we’re half of the ratio — I need you guys to take this seriously.
David Raubach: How did you find out about the governor’s veto?
Melissa Provenzano: I got an email. It’s like the breakup text message — efficient, but yeah. He even made a video about it talking about increasing insurance rates. It was just offensive to me, but I felt this feminine rage — I’m like, this is a marathon, not a sprint, and I’m going to keep going. I went to my leader and the speaker right out of the gate and asked them to consider a veto override, and I had assurances that would be at the top of the list. Out of 60-plus vetoes, we overrode about 47. The governor had said some things about a senator’s wife that he shouldn’t have, and threatened to primary Republicans — and that was very unifying for the legislature.
David Raubach: Your hair looks like it’s starting to grow back. What was the experience like losing your hair, and can you talk about what patients go through getting a wig?
Melissa Provenzano: You kind of hope you’re one of the one-percenters that nothing happens to. There’s cold capping, which is quite expensive and has no guarantee. My husband and I decided we didn’t want to do it. When it starts to fall out — you’ll know. You run your hands through your hair and it comes out in clumps and keeps coming out in clumps and you can’t brush all the loose strands away. My hairdresser was on speed dial. She came in on her day off and cut my hair very short. My husband, who had grown his hair out during COVID, shaved his head too. Then it was still coming out, so we shaved the rest, and I dawned the wig. My insurance covers half the cost and I was able to get a decent one within a week. Wigs have come a long way. But wearing it — so hot, uncomfortable, itchy. If there’s a harsh wind, or it’s raining, or you’re doing something active — is it going to skew? I could barely handle fake nails, so a fake head of hair was a challenge.
David Raubach: It’s good to hear that your insurance covered half the cost. Is that typical? We actually operate a charity called Canci out of the Proton Center that provides wigs for patients, because that moment of losing your hair can be one of the more traumatic moments along the journey.
Melissa Provenzano: In Oklahoma, it is actually state law that some portion of wig costs has to be covered. And a good wig is expensive. It was important to me to wear one on the House floor so I looked strong and healthy. The same gentleman who helped me get my bill on the floor told me afterward, “I had no idea.” And I’m like, well, great — I could tell every day. But I would go into my office and take a break, and that made it manageable.
David Raubach: Did you have to do radiation after surgery?
Melissa Provenzano: No, because I took the entire breast. So I did surgery and then chemotherapy and now I get a Herceptin shot once every three weeks. My cancer was hormone-receptor negative and HER2-positive. Right when I was supposed to transition from the port to just continuing with Herceptin, the developers of the drug notified me that it was now available as a subcutaneous injection. Sign me up. I got the port out — which was super weird because I got to stay awake for that — and now it’s just a shot. One hundred times faster. And my last chemo treatment was at the very end of April. My hair is actually naturally curly and brown and it’s coming back in gray and black but just as thick, starting to wave a bit. I’m a little terrified because it took me until 18 to discover hair gel.
David Raubach: What do you think needs to happen next from a legislative standpoint — either around cancer specifically or healthcare more broadly?
Melissa Provenzano: Early screening across the board is the game changer for cancer. This bill will help. We also had a bill this session that required full coverage of genetic testing. But just having it be law is one thing — exercising the law is another, because most folks don’t know. The education piece matters. KMAN and the Stone Brook Project have already said, “Okay, what’s next?” And I think lowering that mammogram access age — having the data to say we need that — is what’s next in my mind. And there’s a lot of concern about federal Medicaid changes. If Sooner Care funding is cut, Oklahoma is relatively well-positioned for a couple of years, but we’re going to have to figure out something for the long haul. If you get diagnosed with cancer and you don’t have insurance, that’s a battle nobody should have to face.
David Raubach: Thank you so much for joining us today. I really appreciate your time. We need people like you in the state legislature advocating for patients and being public. And I think one of the best things that happened with HB 1389 was actually the governor vetoing it — because it just created so much organic awareness and passion statewide.
Melissa Provenzano: Yes — and now if you live in Guymon, you live in Heavener, Broken Bow, Lawton, Tulsa, Oklahoma City, you are much more likely to have heard about this. The fascinating thing — he didn’t invite me for a bill signing. No ceremonial signing, no pen to save. Whatever. Got the job done is all I really care about. And as for my mom — because of her age they didn’t do chemotherapy. They put her on the Taxol pill and the side effects are harsh. She said, “I’ll only do this many milligrams.” They said, “You should really do more.” She said, “I’m 73. Get busy living.” Family of strong women. Thank you so much for having me on.
Join a Community That Cares
Get weekly stories, research updates, and ways to get involved.