Patient Question: Disease:Breast Cancer Description: Hello Director Chen, on December 30th my mom underwent a total left breast excision and was discharged on January 7th, when she returned to the hospital for extubation on January 22nd, the doctor said there was a lymphatic metastasis and suggested chemotherapy-radiotherapy-endocrine therapy for us to consider, please check the attached report! My mother is 52 years old and has worked hard for the past 30 years to raise several children. What we want is for her to continue to be with us for 20 years and 30 years so that we can return the love she gave us! I hope you can give me the best treatment plan for my mom! Thank you so much! Help wanted:Since the pathology report came out on January 5, the surgeon was informing us to discharge (patients who need chemotherapy are discharged only after one session of chemotherapy) so he told us that chemotherapy made us feel confused when he pulled the tube after two weeks, and he suggested us to find a medical oncologist, who suggested chemotherapy-radiotherapy-endocrine therapy, now let us consider! We are simply can not take the main, if we can not chemo certainly do not want to chemo! Director Chen, how is my mother’s condition? Does she need chemotherapy? Will chemotherapy speed up my mom’s condition? What will happen if I don’t have chemotherapy? Should I follow the chemotherapy-radiotherapy-endocrine therapy program prescribed by the doctor? I hope you can give me the most suitable treatment plan for my mom, I appreciate it. Reply: Your mother’s condition is a common clinical condition, which belongs to pT2N1M0, luminalA type. But there are indeed many controversies in the treatment. 1) Chemotherapy: most experts are against it, a few are for it (see 2013 St Gallen International Consensus on Breast Cancer). My personal preference is chemotherapy. The reason is that our current subtype classification strategy is “alternative subtype classification based on sampling immunohistochemical analysis”, so there are misclassifications, especially in patients with small luminalA tumors but metastatic lymph nodes. 2) Radiotherapy: more controversial. The US NCCN guidelines (see 2014 NCCN Breast Cancer Clinical Practice Guidelines) strongly consider radiotherapy. However, the St Gallen consensus suggests that the following conditions are also present: 1) age <45 years; or 2) > two peri-neoplastic choroidal carcinoma thrombi. My personal opinion is no radiotherapy. The reason is that previous similar studies were clinical studies under non-“modern” systemic therapy, which has a great ability to control local tumors (see studies B32, Z0011). 3) Endocrine therapy: This is not very controversial. There are only some differences in drug selection and treatment cycle. But it does not affect the big picture.