That's a very good question. That's the crux of the matter, I think. We need to move beyond the old data. We need to move beyond 60-year-old data. We cannot use data from before we landed on the moon to determine our breast cancer guidelines now. We are moving into uncharted territory.
I'm not a methodologist. I'm not a guideline expert. I'm not going to pretend I know how to do this, but I do think we need to think about different methodologies and to involve different kinds of data. Right now, although different data is involved, if it's an RCT, even if it's a really old, crappy RCT, it still trumps a non-randomized study. Those numbers from those randomized studies are still driving.
We need to look at what the U.S. is doing. I think we need to use modelling data. There's a new paper just out that shows screening women in their forties saves 3.3 deaths per thousand women screened. Move to modelling and use a lot of the epidemiological data, because our society is changing, the incidence is changing and the ethnic makeup of our society is changing. We have to do more of a holistic investigation to do that.