“Choosing Wisely is an interprofessional campaign launched by the American Board of Internal Medicine (ABIM) to identify tests, procedures or treatments that are unnecessary or may even be harmful to patients, especially asymptomatic patients. The American Society of Clinical Oncology (ASCO), the professional medical oncology society, is committed to attacking cancer through research, education, prevention and the provision of quality patient care. As such, ASCO recognizes the importance of evidence-based cancer treatment and making informed choices about the diagnosis and management of cancer patients. After careful consideration by experienced oncologists, ASCO has identified five categories of tests, procedures, and/or treatments that are frequently used in clinical practice but are not supported by the available evidence. These tests and treatments should not be recommended unless, in the individual case, the physician and patient have carefully considered that such use is appropriate. As an example, when a patient participates in a clinical trial, these tests, treatments, and procedures may be part of the trial protocol and therefore have a need for the patient’s participation in the collaboration. 1. Do not administer tumor-targeted therapy to patients with solid tumors with the following characteristics: poor physical status (score of 3 or 4), no benefit from prior evidence-based therapy, unfit to participate in a clinical trial, and lack of strong evidence to support the clinical value of further anticancer therapy. (1) Studies have shown that targeted therapy is likely to be ineffective in patients with solid tumors meeting the above criteria. (2) Exceptions include patients with poor physical status and functional limitations due to other diseases, and patients with certain disease features (e.g., mutations) that suggest a higher chance of response to therapy. (3) This approach should be taken in conjunction with appropriate palliative and supportive care. 2. Do not use PET, CT and radionuclide bone scan for staging of early stage prostate cancer with low risk of recurrence and metastasis. (1) For staging of specific types of tumors, imaging aspects such as PET, CT or radionuclide bone scan may be of value. However, these examinations are often used for staging evaluation of low-risk cancers, and evidence that this practice may improve metastasis detection or improve survival is lacking. (2) Available evidence does not support the use of these tests for the staging of newly diagnosed low-grade prostate cancer [stage T1c/T2a, prostate-specific antigen (PSA) <10 ng/ml, Gleason score ≤6] with a low risk of distant metastases. (3) Unnecessary imaging can cause harm, including causing unnecessary invasive procedures, overtreatment, unnecessary radiation exposure, and misdiagnosis. 3. Do not use PET, CT and radionuclide bone scan for staging of early breast cancer with low risk of recurrence and metastasis. (1) For staging of specific types of tumors, imaging aspects such as PET, CT or radionuclide bone scan may be of value. However, these examinations are often used for staging evaluation of low-risk cancers, and evidence that this practice improves metastasis detection rates or improves survival is lacking. (2) In breast cancer, there is a lack of evidence to support the benefit of using PET, CT, or radionuclide bone scans in patients with asymptomatic, newly detected ductal carcinoma in situ (DCIS), or in patients with clinical stage I or II. (3) Unnecessary imaging can cause harm, including causing unnecessary invasive procedures, overtreatment, unnecessary radiation exposure, and misdiagnosis. (4) Do not perform surveillance tests (biomarkers) or imaging tests (PET, CT, and radionuclide bone scans) in asymptomatic breast cancer patients who have already received treatment aimed at cure. (1) Surveillance using serum tumor markers or imaging has been shown to be clinically valuable for some cancers (e.g., colorectal cancer). However, in asymptomatic breast cancer patients who have been treated with cure-based therapy, several studies have shown no benefit from routine imaging or serial serum tumor marker testing. (2) Tests yielding false-positive results can be harmful, including causing unnecessary invasive procedures, overtreatment, unnecessary radiation exposure, and misdiagnosis. 5. Do not use leukocyte-stimulating factor for primary prevention in patients with less than 20% risk of neutropenic fever. (1) ASCO guidelines recommend that leukostimulating factor is not needed when the risk of neutropenic fever secondary to the recommended chemotherapy regimen is approximately 20% and the same effective regimen does not require leukostimulating factor treatment. (2) The exception is when, despite being on a chemotherapy regimen that is less likely to cause neutropenic fever, the physician judges the patient to be at high risk for this complication (based on considerations of age, past history, or disease characteristics). (II) Brief Interpretation and Observations The American Society of Clinical Oncology (ASCO) gives five wise choices that are helpful in guiding our clinical work, the most basic of which is to help us reduce over-testing or treatment. Currently, there is a high level of over-screening and over-treatment in the clinical setting. However, some of the five wise choices still need to be applied in practice with the actual situation of the patient. 1. "Do not administer tumor-targeted therapy to patients with solid tumors with the following characteristics: poor physical status (score of 3 or 4), no benefit from prior evidence-based therapy, unfit to participate in clinical trials, and lack of strong evidence to support the clinical value of further anticancer therapy". In fact, clinically, patients with poor fitness status (mainly those with a score of 3) may still benefit from EGFR TKI (currently, the clinically common ones are Erysal, Troche, and Kemena). Such patients should be sure to perform EGFR mutation testing before taking oral EGFR TKI. 2. "Do not use PET, CT and radionuclide bone scan for staging of early stage prostate cancer with low risk of recurrence and metastasis". In clinical practice, many early stage prostate cancers with low risk of recurrence and metastasis have a worse prognosis after a certain period of time than early stage prostate cancers with high risk of recurrence and metastasis. For early stage prostate cancer with low risk of recurrence and metastasis, the author believes that a proper PET, CT and radionuclide bone scan should be given before staging. 3. "Do not use PET, CT and radionuclide bone scan for staging of early breast cancer with low risk of recurrence and metastasis". This is not of great value for use in Chinese women with breast cancer due to the large difference in factors and causative factors between Chinese women and foreign women. Again, it is appropriate to give an appropriate PET, CT and radionuclide bone scan before staging. 4. "Do not perform surveillance tests (biomarkers) or imaging (PET, CT and radionuclide bone scans) in asymptomatic breast cancer patients who have already received treatment aimed at cure". If biomarkers are significantly elevated when a breast cancer patient is diagnosed, they are important in the follow-up of subsequent breast cancer patients, so it is recommended that biomarker monitoring is needed. 5. "Do not use leukocyte-stimulating factor for primary prevention in patients with less than 20% risk of neutropenic fever." In clinical work, patients are prone to nervous situations when neutropenia is present, and sometimes it is better to explain to patients than to apply it early, which will instead help to increase their confidence and enable them to give timely treatment. This is also more difficult to apply in China.