In discussion with one of my colleagues, part of the issue with a lot of these studies is that the end point perhaps is not the right end point we need to look at. The end point is often a hard end point of survival, instead of looking at the stage migration that we achieve with early detection.
I would disagree with the chief surgeon from Manitoba who indicated that the treatment of stage 1 and 2 breast cancer is essentially the same. Historically, that may have been true, but every year we're achieving advances in systemic therapy of breast cancer, where that's no longer the case. Even in the worst actor of triple negative breast cancer, where even a small subcentimetre node-negative tumour gets chemotherapy, one that's larger than two centimetres or has lymph node involvement will have immunotherapy and a more aggressive chemotherapy. Systemic therapy is really working to de-escalate treatment where we can in earlier-stage disease, but also very much escalate for stage 3 disease across the board.
Stage does matter, and I think end points matter. The problem with the evidence review and the lack of expertise is that there is no one there to put it into the context of what it means to treat breast cancer today.