Breast cancer is a systemic disease with a good prognosis. As it has been widely appreciated worldwide, the current treatment for breast cancer is diverse and rapidly progressing, but the principle of treatment for operable breast cancer is still a combination of surgery-based treatment. All clinical studies on breast cancer treatment strategies can be summarized by the ideas of comprehensive treatment, standardization and individualization. The standardized combination treatment for breast cancer includes surgery, chemotherapy, radiation therapy, endocrine therapy and biologically targeted therapy. Surgery remains the most important treatment for breast cancer, but academic opinion has changed significantly since the end of the last century, with a shift from radical surgery and extended radical surgery to modified radical surgery and breast-conserving radical surgery, and several clinical studies on the replacement of axillary lymphatic dissection with biopsy of the anterior lymph nodes. Although the status of surgical treatment has remained untouched to date, there is a consensus in the academic community that a reduction in the scope of breast cancer surgery is acceptable in a standardized comprehensive treatment plan. This assertion is based on the results of clinical practice and is not arbitrary in practice; it requires a comprehensive assessment of the general, clinical and pathological characteristics of the breast cancer patient and is feasible under the premise that a treatment plan is developed and can be strictly implemented. The adjuvant treatment plan before and after surgery for operable breast cancer is very important and may affect the outcome of treatment in several ways. One is that preoperative neoadjuvant therapy directly affects the success rate of tumor-free surgery and breast conservation, especially in cases with large tumor lesions, where neoadjuvant therapy, especially neoadjuvant chemotherapy, can shrink the tumor and reduce the difficulty of surgery (mainly the difficulty of strictly following the principles of tumor-free surgery and the difficulty of ensuring the appearance of the breast after complete removal of the tumor). Currently, there is a tendency to question the role of neoadjuvant chemotherapy as it has little impact on the tumor-free and overall survival of treated breast cancer. However, we believe that the role of neoadjuvant chemotherapy is not the most important aspect, but the real significance of neoadjuvant chemotherapy is to kill microscopic/concealed metastatic lesions that may exist in the body or exfoliated tumor cells that have the potential to form metastatic foci in the circulation. This view is more theoretical, but also more in line with Fisher’s original theory that breast cancer is a systemic disease, and a German study suggested that detection of peripheral tumor cells could be used as a surrogate endpoint to evaluate the efficacy of neoadjuvant chemotherapy, confirming the validity of our view from the side [2]. The second aspect of pre- and postoperative adjuvant therapy that affects the efficacy is the complementation and consolidation of the surgical efficacy. Not all tumor lesions can be cured after surgery, and the tumor cells shed and spread through various ways are the root cause of tumor recurrence and metastasis in the future, and surgery and medical operation itself may also promote tumor shedding and spreading. The theoretical basis and clinical effectiveness of 4-8 cycles of neoadjuvant chemotherapy combined with surgery and free from postoperative chemotherapy advocated by some foreign scholars are subject to debate and further validation. Radiation therapy for breast cancer is usually administered after surgery, and the current practice is to start treatment after surgery and 4-8 weeks after the completion of adjuvant chemotherapy. The NCCN guidelines recommend radiotherapy for cases with ≥4 axillary lymph node metastases, and for cases with 1-3 lymph node metastases. The clinician will also consider the extent of surgery, vascular invasion, peri-cancerous connective tissue infiltration, etc., in order to determine whether or not to give radiotherapy. The indications and scope of radiation therapy after operable breast cancer need more evidence-based medical evidence. Some cancer centers are seeking the rationale and clinical data for local irradiation after breast-conserving surgery, and if this protocol is proven to be effective, it will further reduce the damage to the patient and ensure a greater cosmetic effect. The significance of endocrine therapy for breast cancer has been confirmed. Triamcinolone acetonide has shown good efficacy in both pre- and post-menopausal breast cancer patients, effectively reducing the rate of recurrence and metastasis after breast cancer surgery and improving the tumor-free and overall survival rates; aromatase inhibitors are effective in the treatment of post-menopausal breast cancer, and the latest reports show that the tumor-free and overall survival rates after aromatase inhibitor treatment are better than triamcinolone acetonide, while the The overall adverse effects are comparable. It can be said that the use of estrogen receptor antagonists or aromatase inhibitors for hormone receptor positive breast cancer is beyond doubt, but the question that needs to be addressed is the difference in efficacy between the sequential application of the two and their single and combined use, as well as the time frame of application. Recent studies have concluded that sequential application is superior to triptans alone, and that aromatase inhibitors are superior to triptans or sequential regimens in postmenopausal patients. The main biologically targeted therapies for breast cancer are trastuzumab Herceptin and the tyrosine kinase inhibitor Lapatinib, which can be applied after chemotherapy or concurrently with chemotherapy and have been reported in the literature to be effective in improving the outcome of breast cancer treatment. The main drawbacks are cardiotoxicity and high cost, which limit clinical use, as well as the high failure rate of Herceptin and the ongoing clinical studies of Lapatinib. Regardless of endocrine therapy or biologically targeted therapy, the prerequisite for treatment implementation is accurate molecular marker testing. The Chinese Anti-Cancer Association Breast Cancer Treatment Specification requires ER, PR and C-erb-B2 testing to be performed by qualified laboratories to ensure accurate and reliable results and standardization of targeted therapy. Individualization of comprehensive treatment The standardization of comprehensive treatment does not require that all breast cancer patients adopt the same treatment plan, but rather the individualization of treatment in clinical practice. It is also a kind of standardization to give different treatment to different individuals according to the characteristics of their disease and according to evidence-based medicine. Nowadays, the strategy of individualized comprehensive breast cancer treatment is based on the classification of breast cancer risk, sex hormone receptor expression, HER2/neu gene amplification or protein overexpression, with clear indications for targeted therapy and/or chemotherapy [9]. They are sex hormone receptor and HER2 gene. The NCCN guidelines have recommended chemosensitivity genetic testing for breast cancer as a basis for selecting chemotherapy, but the St. Gallen Breast Cancer Conference and the St. Antonio Breast Cancer Forum do not recommend it yet. However, the St. Gallen Breast Cancer Conference and the St. Antonio Breast Cancer Forum have not recommended this, and there is controversy regarding the molecular biology of chemotherapy susceptibility and the corresponding laboratory tests. The 2007 St. Gallen Breast Cancer Conference summary of breast cancer treatment strategies and risk classification. The consensus of the meeting classified the responsiveness of breast cancer endocrine therapy (ET) as: high response – high expression of both ER and PR in most tumor cells; incomplete response – low expression of HR or no expression of either ER or PR; and no response – no detectable expression of HR. ET is effective for both tumor prevention and ET is effective for both tumor prevention and DCIS, so it can be considered alone in some patients with very low-risk invasive ductal carcinoma. patients with high and incomplete response to ET can be considered for additional chemotherapy according to HR and risk classification. Trastuzumab is not routinely used in patients with primary foci <1 cm and negative LN, especially in patients with high or incomplete ET response. According to available clinical evidence, trastuzumab should be administered concomitantly with chemotherapy (CT) or followed by the end of chemotherapy, but some experts agree that in the future trastuzumab can be administered before or without chemotherapy. Regarding the risk classification of breast cancer, some experts believe that pT1a and pT1b stage tumors with negative lymph nodes should be considered as low risk even if the histologic grade is high and/or the patient is young; some tumors such as medullary carcinoma or mammary gland sweat cancer can be considered as low risk even if there is no HR expression. Intermediate-risk patients include those with negative lymph nodes and 1-3 positive lymph nodes. In patients with negative lymph nodes, extensive peritumoral vascular infiltration increases the risk of disease, but not in patients with positive lymph nodes. Various oncology or breast cancer specialty forums/guidelines advocate that HER2/neu gene amplification or protein overexpression needs to be detected by a credible immunohistochemical assay or FISH. It is easy to see from the above two tables that most scholars have an attitude towards systemic treatment strategy for breast cancer, i.e., target-related targeted therapy is considered first, and then additional chemotherapy is considered according to risk grading. The age, menstrual status, tumor size, tumor cell grading, local invasion, local lymph node metastasis, hormone receptor status and HER2/neu gene amplification or protein overexpression must be taken into consideration when formulating individualized treatment strategy, in order to truly individualize treatment according to individual and disease. The choice of endocrine therapy drugs is mainly based on menstrual status, HER2 gene targeted therapy depends more on the patient's cardiac function status and economic conditions, and there is no complete agreement on chemotherapy regimen. Currently, there are many adjuvant chemotherapy regimens for breast cancer at home and abroad, and different countries and different clinical centers have their own preferences. However, in recent years, due to the release of the results of several large multicenter clinical trials, the consensus is that anthracyclines and paclitaxel have good efficacy in breast cancer, and most of the chemotherapy regimens are either anthracycline- or paclitaxel-based combination regimens or combination regimens of anthracyclines + paclitaxel. The consensus reached at the major academic meetings including SABCS, ASCO BCS, and St. Gallen Breast Cancer Conference is that none of the above two combination regimens is considered superior to the other, and none of them is recommended as the preferred regimen. TEC, etc. have shown good efficacy. Local treatment strategies for operable breast cancer tend to be more consensus than controversy in academic circles, and the differences in individualized treatment strategies mainly lie in the indications for breast conservation, alternative axillary clearance of anterior lymph nodes, and the applicable scope of radiotherapy. There are major differences between China and western countries in the first two items, and the indications for breast conservation in China are more strictly controlled, and it is more difficult to implement alternative axillary clearance of anterior lymph nodes. Given the ethnic differences between the East and the West, it seems that the indication for breast conservation in China should take into account the proportion of the mass to the breast rather than just the size. As mentioned above, the need for radiotherapy in patients with 1-3 metastatic axillary lymph nodes and in patients without metastatic lymph nodes with peri-cancerous infiltration is yet to be further substantiated by evidence-based medicine.