The change and update of breast cancer treatment philosophy is derived from the progressive understanding of the biological behavior of breast cancer. The understanding of breast cancer as a systemic disease has replaced the old concept of breast cancer as a localized disease, and what has emerged is a comprehensive treatment model for breast cancer. The so-called comprehensive treatment of breast cancer is the combined use of multiple treatments according to the biological behavior of the tumor and the physical condition of the patient. Surgeons, radiologists, chemotherapists, pathologists and diagnostic imaging doctors are all involved in the design of the overall treatment plan and maintaining the cooperation among the therapies during the treatment process to strengthen the concept of holistic treatment. Integrated treatment of breast cancer is based on “evidence-based” medicine, and is based on the results of a large number of controlled clinical studies. Medical practice has confirmed that integrated treatment of breast cancer takes into account both local and systemic treatment, reduces the scope of surgery, improves physical results, maintains the function of the upper limbs, and improves the overall survival rate. The upper limb function is maintained and the quality of life is improved. Comprehensive treatment is the direction of breast cancer treatment and the key to success or failure of breast cancer treatment. Surgery plays an important role in the diagnosis, staging and comprehensive treatment of breast cancer. As far as the surgical treatment of breast cancer is concerned, W.S. Halsted pioneered the radical surgery of breast cancer in 1894 at Johns Hopkins Hospital in the United States, removing the tumor, the whole breast, the pectoral muscle and the regional lymph nodes, which greatly improved the level of surgical treatment of breast cancer at that time and was regarded as the “classic” radical surgery of breast cancer and was widely used. It was widely used. However, this procedure not only destroyed the perfect body shape of women, but even discouraged some women from participating in the early detection of breast cancer, but Halsted surgery still ruled for most of the century. As treatment concepts evolved, the Halsted procedure was challenged in the 1950s by the more extensive enlargement procedure and in the 1960s by a modified radical procedure that reduced the extent of the procedure (removing part or all of the breast muscle). However, the wave of reduction surgery did not stop with modified radical surgery, and in the 1980s, breast-preserving surgery was introduced. Internationally influential cancer centers published the results of randomized controlled studies over 20 and even 30 years, providing strong evidence for breast-conserving surgery as an alternative to radical surgery in the treatment of early-stage breast cancer. Breast-conserving surgery involves removing only the tumor and axillary lymph nodes, preserving the breast, and administering radiation therapy after surgery. There are strict indications for breast-conserving surgery, including tumor size, location, and clinical stage. Breast-conserving surgery has been performed in Europe and the United States for a long time, and with the increase of early breast cancer cases due to breast cancer screening, breast-conserving surgery has exceeded 50% of all breast cancer surgeries. The results of the prospective multicenter study on breast-conserving comprehensive treatment of early-stage breast cancer, which was jointly completed by ten tertiary hospitals in China, show that 872 breast-conserving surgeries were performed from November 2001 to November 2004, accounting for 19.5% of all breast cancer cases eligible for breast-conserving treatment and 9.0% of all operable breast cancer cases in the same period. This is much lower than that of European and American countries. The main reason for this is the perception of breast-conserving treatment, not knowing that early-stage breast cancer can be treated with breast-conserving treatment, and even if they have heard about it, they are not sure about it. Of course, whether it is early-stage breast cancer and whether it can be breast-conserving should be determined by oncologic surgeons according to the condition, and should not be handled arbitrarily. In order to improve the quality of life, repair the psychological trauma and restore self-esteem and self-confidence, it is possible to reconstruct the breast using plastic surgery techniques. Breast reconstruction can be done with autologous tissue grafting or with implants. Breast reconstruction can be performed at the same time as the tumor removal surgery, which is called phase I reconstruction, or phase II reconstruction after the completion of the treatment and when all reviews are normal. Studies have shown that breast reconstruction does not affect the treatment of breast cancer, but on the contrary, breast cancer treatment sometimes affects the cosmetic results of breast reconstruction. Therefore, it is up to the oncologists and plastic surgeons to determine whether and when breast reconstruction can be performed, taking into account the patient’s specific situation. Breast-conserving surgery and breast reconstruction are the development trend of breast cancer surgical treatment in China, and there will be a wide scope of development in China. Breast-conserving surgery still requires axillary lymph node dissection, i.e., removal of all lymph nodes in the axilla, with the purpose of removing metastatic lymph nodes and, more importantly, determining the stage, estimating the prognosis, and deciding the next treatment plan. After axillary lymph node dissection, it is found that 50% of patients have no metastasis in the axillary lymph nodes, and 15% to 25% of patients will develop lymph node edema or chronic pain in the upper extremities after surgery. In the 1990s, a new lymph node biopsy technique, sentinel lymph node biopsy, was gradually developed and promoted. The so-called sentinel lymph node is defined as the lymph node in the tumor lymphatic drainage area where the tumor metastasis occurs earliest. With the mastery of this technique, it is possible to remove the sentinel lymph nodes (most patients have 1 or 2 axillary sentinel lymph nodes) first and determine whether there is metastasis by rapid pathological examination to indirectly understand the status of axillary lymph nodes; if there is metastasis, axillary lymph node dissection is feasible, but if there is no metastasis, the axilla can be left untreated, which reflects the concept of humane and individualized treatment. This test has been popularized in Europe and the United States, and the accuracy rate can reach more than 95%, but only a few hospitals in China have applied it in clinical practice. 2.Radiotherapy is the use of radiation to destroy the growth and reproduction of cancer cells, so as to control and destroy cancer cells. Radiation has certain killing power. By controlling the dose of radiation and mastering the time of irradiation, cancer cells can be killed when they replicate by taking advantage of the fact that they proliferate faster than normal cells and are more sensitive to radiation, so as to achieve the purpose of eliminating tumors. At present, there are three types of radiation used in treatment: α, β and γ rays produced by radioisotopes; X-rays of different energies produced by X-ray treatment machines and various gas pedals; electron beam, proton beam and neutron beam produced by various gas pedals, etc. After local excision of limited intraductal carcinoma (carcinoma in situ) and breast-conserving surgery for stage I and II invasive ductal carcinoma, radiation therapy is needed to prevent and reduce local recurrence; for advanced breast cancer that has lost the chance of surgery, radiation therapy can achieve better local control and improve survival rate; for breast cancer with distant metastasis such as brain metastasis and bone metastasis, radiation therapy can control the disease, prolong life and improve For breast cancer with distant metastases such as brain metastases and bone metastases, radiation therapy can control the disease, prolong life and improve quality of life. The common complications of radiation therapy include local skin reaction, upper limb or breast edema, breast fibrosis, pneumonia, pulmonary fibrosis, rib fracture, etc. Therefore, radiation therapy has its corresponding indications, and doctors should weigh the pros and cons. During radiotherapy, patients should pay attention to health care and strengthen the body resistance to ensure the successful completion of treatment. With the continuous research on high-energy physics and radiobiology, the continuous updating of radiotherapy equipment and the continuous maturation of radiotherapy techniques, the radiation therapy for breast cancer has developed rapidly in recent years, and the research on intensity-modulated conformal radiotherapy after breast-conserving surgery and short-course radiotherapy for part of the breast also reflects the humanistic concept of reducing therapeutic injuries, simplifying treatment procedures and focusing on quality of life. Intense conformal radiotherapy provides a more concentrated and uniform dose to the originally planned irradiation site with minimal exposure to normal tissues. Intraoperative radiotherapy for breast cancer is currently under clinical research in the international arena. If the efficacy is reliable, it will avoid all the inconveniences caused by postoperative radiotherapy and solve the problems in the interface of radiotherapy and chemotherapy. In recent years, European and American countries have carried out the study of axillary sentinel lymph nodes. Patients with positive sentinel lymph nodes were divided into two groups, one group received axillary lymph node dissection and one group received radiotherapy in the axillary area, once the efficacy is the same, axillary radiotherapy is expected to replace axillary surgery and reduce many complications caused by axillary surgery. 3, chemotherapy (chemotherapy) chemotherapy is a systemic adjuvant therapy, started in the 1970s, when the CMF regimen (cyclophosphamide + methotrexate + fluorouracil) was chosen, and the long-term survival rate of patients taking the drug with lymph node metastasis increased by more than 30% at 30 years of follow-up. With the introduction of new chemotherapeutic agents and the accumulation of experience in chemotherapy, chemotherapy has evolved from “maximum tolerated dose therapy” to “minimum effective dose therapy”. In the past 20 years, randomized controlled studies have been conducted on the indications for systemic adjuvant chemotherapy, the types, doses, intensities and densities of drugs, the timing and duration of administration, and whether the drugs should be administered simultaneously or sequentially, so that the blindness of systemic adjuvant therapy has been somewhat improved. The escalating emphasis on systemic treatment of breast cancer is gaining noteworthy momentum. Studies have shown that combination chemotherapy regimens are superior to single-agent chemotherapy, multi-cycle chemotherapy is superior to single-cycle chemotherapy, from CMF (cyclophosphamide, methylaminopurine, fluorouracil) regimens in the 1970s to anthracycline (doxorubicin or epirubicin) regimens in the 1980s, to paclitaxel (paclitaxel, doxorubicin) regimens in the 1990s, to the development of biologically targeted therapy and chemotherapy in recent years The combination of biologic targeted therapy and chemotherapy in recent years. The indications for adjuvant chemotherapy have been expanded from positive axillary lymph nodes to negative axillary lymph nodes, and from postoperative chemotherapy to preoperative chemotherapy, i.e. neoadjuvant chemotherapy, so that some unresectable breast cancers can be resected and some cases that cannot be treated with breast-conserving therapy can be preserved. In recent years, neoadjuvant chemotherapy has also developed from advanced cases to stage I and II cases, and from conventional to intensive chemotherapy. These researches have made the adjuvant chemotherapy for breast cancer achieve striking efficacy and greatly improved the survival rate of breast cancer patients. Endocrine therapy As early as 1896, it was reported that middle-aged women with metastatic breast cancer were in remission after removal of ovaries. Later, we saw successive reports that performing bilateral oophorectomy could treat late premenopausal breast cancer …… thus confirming that the growth of some breast cancers (hormone-dependent breast cancer) is related to endocrine hormones. In the early 1960s, some foreign scholars discovered through animal experiments that estrogen cannot enter the cell directly, but must bind to a substance inside the cell in order to work. Estrogen receptors bind specifically to estrogen, progesterone receptors bind specifically to progesterone, and other hormone receptors. There are various methods to detect hormone receptors in breast cancer tissues, and most hospitals currently use immunohistochemistry (immunohistochemistry), which is a mature technology and provides a reliable reference for clinical treatment. The results of hormone receptor measurement correlate with the prognosis of breast cancer and the effectiveness of endocrine therapy. In most cases, receptor-rich tumor cells are often better differentiated, less malignant and have a better prognosis; the receptor content is also proportional to the effect of endocrine therapy; the higher the receptor content, the better the effect of endocrine therapy. In other words, patients with positive receptors for both estrogen and progesterone have better results than patients with one positive receptor or both negative receptors. Patients with positive receptors require endocrine therapy. Currently, the majority of patients are treated with drugs, and a very small number of premenopausal patients with locally advanced breast cancer or treatment failure have undergone bilateral oophorectomy (depot treatment). Here are several drugs for endocrine therapy: Triamcinolone acetonide (tamoxifen, TAM), synthesized in 1966 and used for breast cancer treatment in 1971, is the core drug for endocrine treatment of breast cancer and has also been tried in the United States in recent years for the prevention of breast cancer in high-risk groups. Side effects of triamcinolone include hot flashes, appearance of vaginal discharge, abnormal menstruation, and skin rash, but the incidence is low and discontinuation of the drug due to side effects is rare. It is clear about the safety of long-term administration, i.e., this product can induce endometrial polyps, endometrial proliferation and endometrial cancer, and cause visual abnormalities, becoming the most important concern in the application of triamcinolone acetonide, and regular gynecological examinations should be done to monitor the thickness of the endometrium. If the side effects are obvious, it can be changed to toremifene (Faradone), a chlorine-containing derivative of triamcinolone, which was synthesized in 1986 and has lower side effects than triamcinolone. The short-term follow-up efficacy is not significantly different from that of triamcinolone, but there are no long-term follow-up results to evaluate accurately. Triamcinolone and toremifene can be used in premenopausal as well as postmenopausal receptor-positive patients. Another class of endocrine therapeutic agents are aromatase inhibitors. The more commonly used 3rd generation aromatase inhibitors such as anastrozole (Renindezvous), letrozole, and exemestane (Anoxin) …… are indicated for postmenopausal patients. One study reported that aromatase inhibitors are superior to triamcinolone acetonide for endocrine therapy in postmenopausal receptor-positive patients. The results of the study so far show that the duration of endocrine therapy is best for 5 years. Molecular targeted therapy is one of the most active research areas in recent years, and is a new type of antitumor therapy with multi-linked mechanism of action compared with chemotherapy drugs. For example, Herceptin, which was approved by FDA in October 1998, is the world’s first humanized monoclonal antibody therapy for HER2 overexpressed tumors. Herceptin can bind specifically to the HER2 protein receptor and may subsequently act to inhibit or kill tumor cells through two pathways. There are two methods to clinically detect HER2 status in tumor tissues of breast cancer patients, immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). The compliance rate between the two methods is above 90%. Immunohistochemistry result of (3+) or FISH result of amplification are indications for Herceptin treatment; if immunohistochemistry is (2+), it is better to perform FISH again; if immunohistochemistry is 0 or (1+), or FISH is non-amplification, treatment with Herceptin is not suitable. Herceptin can be used as monotherapy or in combination with chemotherapy drugs, and its toxic side effects are mainly the increased incidence of congestive heart failure. several articles reported in the International Breast Cancer Symposium held in the United States in December 2005 that Herceptin combined with chemotherapy can improve the efficacy of adjuvant therapy after surgery for HER2-positive early-stage breast cancer. Due to the high price of Herceptin, it is not yet popular in China. The development of molecular targeted drugs and clinical trial research are expected to promote the development of comprehensive breast cancer treatment. 6.Chinese herbal medicine treatment is also part of the comprehensive treatment of breast cancer. The treatment of tumor in TCM emphasizes the principle of regulation and balance, through two-way regulation, overall regulation, self-regulation and functional regulation, to restore and enhance the internal resistance of the body, so as to achieve the purpose of treating the disease with the balance of yin and yang. Surgery, radiotherapy, chemotherapy, and even biologically targeted therapy all inevitably damage the normal functions of the body while treating breast cancer. To reduce the damage of radiotherapy, chemotherapy and surgery and to improve the body’s defense ability against tumor, the most ideal way is to apply the above treatments together with Chinese herbal medicine. The evidence-based treatment of TCM is worth advocating to reduce the toxic side effects of chemotherapy and radiotherapy, consolidate and strengthen the therapeutic effect of tumor and improve the quality of life of patients; TCM can also target the symptomatic treatment of advanced breast cancer to relieve symptoms, alleviate pain and prolong life.