Breast cancer is the most common malignant tumor in women. According to incomplete statistics, from 1998 to 2007, the average annual incidence of breast cancer in Chinese women in urban tumor registration areas was about 45.46/100,000, and the average annual incidence in rural areas was about 14.86/l0 million, and the incidence rates were on the rise. According to the forecast, by 2015, the incidence rate of breast cancer in China will be about 53.87/100,000 for urban women and 40.14/100,000 for rural women. Although there are several treatment strategies such as NCCN guidelines, St Gallen Consensus and the guidelines and norms of the Chinese Anti-Cancer Association Breast Cancer Committee, and the effect of comprehensive treatment is obvious, the author still found some misunderstandings in treatment in daily clinical work, among which the over-surgery and post-operative radiation therapy are the main ones, which are summarized as follows Breast cancer surgery has gone through a long process from the initial extended radical surgery to the later modified radical surgery, one of the important reasons is the awareness of breast surgeons. NSABP-06 showed that the overall survival rate of breast-conserving and modified radical surgery patients were 47% and 46%, respectively, and the local recurrence rate was 8.8% and 2.3%, respectively, after 20 years of follow-up. The Guidelines and Standards for Breast Cancer Treatment of the Chinese Anti-Cancer Society suggest that stage I and Il breast cancer are suitable for breast-conserving surgery, while axillary lymph node metastasis is not a contraindication to breast-conserving surgery. The current status of breast-conserving surgery at home and abroad is as follows: the breast-conserving rate of early-stage breast cancer in Europe from 2003 to 2010 is about 73.3%, and the modified radical surgery only accounts for 25.1%, and decreases by 4.26% year by year; the statistics of several research institutions in the United States also show that breast-conserving surgery accounts for more than 50% of early-stage breast cancer surgery, while the breast-conserving rate of breast cancer in major cities such as Beijing and Shanghai in China is about 10%-20%. In China, the breast-conserving rate for breast cancer in major cities such as Beijing and Shanghai is about 10% -20%, while the breast-conserving rate in local hospitals is less than 5%. Previous literature reported that the main reasons for the low breast-conserving rate in China are: (1) Insufficient early screening efforts leading to late stage of disease when patients are seen. (2) low prevalence of postoperative radiotherapy for breast cancer; (3) false-positive results of breast MRI that reduce the breast-conservation rate to some extent. For example, a randomized controlled clinical study of 794 breast cancer patients undergoing breast-conserving surgery in the United States showed that the use of preoperative MRI did not significantly improve the success rate of breast-conserving surgery and reduce the rate of recurrent re-excision. However, the author believes that the fundamental reason is the conservative awareness of physicians and the inadequate science education of patients. For a patient who has just been diagnosed with malignant tumor, the huge psychological impact will make her choose the total mastectomy, which is “the cleaner the better”, and she may regret her choice only when she continues to live healthily years later but loses her breast and her self-esteem as a woman. The large scale clinical trials such as NSABP-32 and ALMANAC have confirmed that sentinel lymph node biopsy is a safe and reliable axillary staging procedure for early stage breast cancer with significantly fewer complications than axillary dissection. As long as no lymph node metastasis is found in the clinical judgment, sentinel lymph node biopsy is recommended for stage I and II breast cancer, regardless of whether breast-conserving surgery, total mastectomy, or skin-preserving mastectomy is performed. Even though the presence of clinically suspicious axillary lymph nodes was once considered a relative contraindication to sentinel lymph node biopsy, however, clinical examination and pathologic evaluation have confirmed that clinical examination is falsely positive in 53%; moderately suspicious patients and 23%; highly suspicious patients. Therefore, there is no reason to completely exclude clinically suspicious lymph nodes from sentinel lymph node biopsy. Although national and international treatment guidelines now recommend axillary dissection for patients with positive sentinel lymph nodes, several studies, including the well-known Z0011 trial, have suggested that axillary lymph node dissection may be avoided in patients with small tumors, no vascular thrombus invasion, and only one to two positive sentinel lymph nodes, especially after breast-conserving surgery with complete postoperative radiation therapy. The IBCSG 23-01 phase III randomized controlled study concluded that patients with tumors smaller than 5 cm and micro-metastases in the anterior lymph nodes did not have a significantly different disease-free survival and overall survival than those in the node dissection group, but the incidence of neuropathy and lymphedema was much lower. the results of the AATRM study also concluded that axillary lymph node dissection for micro-metastases in the anterior lymph nodes did not provide clinical benefit. With the increasing use of neoadjuvant chemotherapy in patients with smaller tumors with clinically negative axillary lymph nodes, the avoidance of axillary node dissection has become a point of debate. Current ASCO guidelines do not recommend neoadjuvant chemotherapy followed by sentinel lymph node biopsy, but rather chemotherapy preceded by sentinel lymph node biopsy as an option. The results of the SENTINA prospective multicenter study, initiated by scholars from Germany and Austria, confirm that the technique of sentinel lymph node biopsy after neoadjuvant chemotherapy not only has a significantly lower detection rate, but also has a significantly higher false-negative rate. It is recommended that anterior lymph node biopsy be performed prior to neoadjuvant chemotherapy if necessary, or axillary lymph node aspiration prior to chemotherapy to avoid false negatives. Overrepresentation of surgical biopsies without preoperative puncture The American College of Surgeons, in its Seven Myths of Surgery presented this year, clearly states that for breast masses that can be, do not perform surgical removal of the mass unless biopsy puncture is not possible. In the case of my hospital, every year hundreds of patients whose pathology is considered malignant after biopsy complete secondary surgery here, and because of the hospital’s limited medical resources, often these patients still need to wait a long time after biopsy for the next step in treatment, which is a great burden on their bodies and minds, and the reason for this is that the puncture biopsy of the mass is seriously underdeveloped, and a large part of the reason for this This of course is also related to the poor understanding of physicians and their failure to correct patients’ misconceptions. After all, there is no study that clearly indicates that preoperative puncture will lead to tumor metastasis or dissemination. In addition, preoperative puncture characterization has an important role in guiding the choice of surgical plan, for example, surgeons preparing for breast-conserving surgery can directly remove the safe area next to the tumor during the surgery after clear diagnosis, avoiding the repetitive work of biopsy first and then removing the surrounding tissues; similarly, for patients with large masses whose puncture is intraductal cancer, it is important to consider that neoadjuvant chemotherapy may not be effective, thus choosing to perform surgery first Similarly, for patients with large masses punctured as intraductal carcinoma, it is important to consider that neoadjuvant chemotherapy may not be effective and thus opt for surgery first. The utilization rate of radiotherapy is low, and many patients with indications do not receive appropriate radiotherapy A domestic multicenter clinical epidemiological study led by our hospital showed that from 1999 to 2008, only 48.8% of high-risk patients who needed radiotherapy after modified radical surgery received radiotherapy, compared with more than 80% abroad. After breast-conserving surgery, 83.7% of patients received radiotherapy, compared to more than 90% abroad. Only 3.6% of the whole group of patients received palliative radiotherapy, compared with about 20% abroad. There are many reasons for the low utilization rate of radiotherapy, such as the imperfect standard of multidisciplinary integrated treatment and patients’ refusal of radiotherapy for economic reasons. However, it may not have much to do with radiotherapists, because the two national radiotherapist questionnaire surveys conducted by the Cancer Hospital of Chinese Academy of Medical Sciences in 2004 and 2010 showed that radiotherapists could grasp radiotherapy indications very well. To improve the penetration rate of radiotherapy, multidisciplinary cooperation is needed. The receiving doctors of surgery and chemotherapy departments need to understand the principles of radiotherapy and recommend patients to go to radiotherapy departments. Also, for patients with financial difficulties, simple and economical radiotherapy techniques should be used as much as possible. The radiotherapy techniques used in the randomized studies that confirmed the effectiveness of radiotherapy for breast cancer were all simple two-dimensional radiotherapy. In other words, breast cancer can be treated well with simple two-dimensional conventional radiotherapy techniques with a low incidence of adverse effects. Radiotherapy techniques should be individualized. Complex radiotherapy techniques may not improve the outcome. The chest wall and the lymphatic drainage area above and below the clavicle that need to be irradiated after modified radical mastectomy are superficial, and simple conventional radiotherapy techniques can achieve good results. Our data show that the 5-year local area recurrence rate of electron beam radiation therapy to the chest wall after modified radical mastectomy for breast cancer is only 5.9%. According to the data of M.D. Anderson Cancer Center in the United States, the 5-year local recurrence rate of patients treated with 3-dimensional radiotherapy and 2-dimensional radiotherapy after 2000 was 3% and 11.5%. However, since advances in chemotherapy, endocrine therapy, and targeted therapy after 2000 also reduce the local recurrence rate of tumors, it is difficult to attribute the reduction in recurrence rate solely to the use of 3D-adaptive radiotherapy. Patients after modified radical surgery requiring precise localization and dosing of regional lymph nodes may benefit from moderate intensity modulated radiotherapy. A meta-analysis showed that conventional tangential field radiotherapy after breast-conserving surgery significantly reduced failure rates, both locally and distantly, with 10-year failure rates of 19.3% and 39.0% for patients treated with and without radiotherapy, respectively, with little room for further improvement in outcomes through improved radiotherapy techniques. Intensity-modulated radiotherapy after breast-conserving surgery has only been shown to reduce the side effects of radiotherapy, with a good dosimetric advantage for patients with large breasts. Randomized studies in Europe and the United States have shown that complex intensity-modulated radiotherapy after breast-conserving surgery significantly reduces the incidence of acute wet skin reactions and improves late cosmetic outcomes compared to the two-dimensional tangential field + wedge plate technique. For example, in patients with intraductal carcinoma, the guideline treatment standard for estrogen receptor (ER)-positive patients, whether menopausal or not, is oral tamoxifen, and the use of aromatase inhibitors may be suspected to be excessive, and whether patients with intraductal carcinoma (including some with microinfiltration) need adjuvant (or neoadjuvant) chemotherapy or even HER-2 therapy. In addition, the guidelines clearly state that endocrine therapy is sufficient for postmenopausal patients with stage I invasive ductal carcinoma and hormone receptor positive, but some physicians still give adjuvant chemotherapy or targeted therapy; patients with mucinous adenocarcinoma without lymph node metastasis and hormone receptor positive still insist on adjuvant chemotherapy. For premenopausal patients, due to the lack of clear criteria, there are many cases of abusive ovarian debulking treatment. However, because there is no centralized statistical analysis of all the above cases, and they are more likely to exist in daily work, the author would like to remind everyone to avoid such cases. In conclusion, in the treatment of breast cancer, which is increasingly supported by evidence-based medicine, as doctors, we need to be as fully informed as possible about the latest research findings and give the most appropriate treatment to patients to avoid over-treatment and under-treatment.