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thank you doctor for kuma and thank you to the ISC for the invitation to be here besides West Cancer Center being in Memphis we can claim the birthplace of rock and roll and we are also the home of Elvis Presley or weamp;#39;re the home for Elvis Presley okay so youamp;#39;re gonna bring the u.s. perspective and really what weamp;#39;re looking at in terms of discussing this trial is percutaneous cryoablation is a primary treatment for low-risk early stage breast cancer and the real question is are we ready for that so in the u.s. weamp;#39;re always asking the question can we do less and we know that there are trends and breast cancer removal surgery that have gone from radical Halsted radical mastectomy to the days of the modified mastectomy the total mastectomy plus radiation and then dr. Viren EC and dr. Bernard Fisher in New England Journal of Medicine in 2002 showed ten-year results and then later 20-year results that showed breast conservation was equal to mastectomy and con