Breast cancer has evolved rapidly over the past 50 years, from early tumor detection, early diagnosis, genetic testing, and now local and systemic breast cancer surgery. Today’s treatment philosophy for breast cancer is no longer to cut bigger and bigger, but to replace traditional radical surgery with modified radical surgery, breast-preserving surgery has become the preferred option, and preoperative neoadjuvant therapy has made it possible for patients who previously could not preserve their breasts to do so. A 50-year review of the history of surgical treatment of breast cancer shows that for patients treated with surgical resection, in principle, “as little as possible with a clean cut”. The long-term survivors who underwent extensive excision were fortunate enough to survive, but unfortunate enough to have a poor quality of life after extensive excision and axillary debridement. In fact, since more than 100 years ago, breast cancer treatment insisted on “cutting cleanly” and always emphasized to cut thoroughly, but research found that the so-called cutting thoroughly is not necessarily better treatment, so there is a continuous evolution from radical treatment, modification, breast conservation, reconstruction and anterior post to “cutting less and less”. This is why there has been a continuous evolution from radical, modified, breast-conserving, reconstructive and anterior to “less and less”. A rigorous clinical study of patients with negative axillary sentinel lymph nodes, with no further axillary dissection, was designed to suggest that accurate axillary sentinel lymph node biopsy in patients with negative axillary lymph nodes could replace axillary lymph node dissection and save these early patients from axillary dissection. In fact, the answer to the question of whether patients with positive axillary sentinels need axillary dissection is “no”. For patients with one or two anterior metastases, it is possible to do without debulking, and this comes from a clinical trial called Z0011, which looked at overall survival and recurrence-free events in patients with one or two anterior metastases, with no difference between the anterior and axillary debulking groups. However, it should be noted that the study selected patients with small tumors and who received breast-conserving radiotherapy to do some of these studies, so the study is limited in the amount of information it provides on clinical practice. Therefore, it is important to interpret the literature to understand in detail the study conditions and inclusion criteria at the time, and the study findings should not be taken out of context for clinical use. It is also mentioned whether neoadjuvant patients can be pre-posted, of course they can, but try to complete it before neoadjuvant therapy. Some scholars have also suggested whether patients with positive axillary nodes before treatment can have axillary node biopsy instead of axillary clearance after neoadjuvant treatment, which may determine the status of axillary nodes after treatment, but it must be clear that such patients with positive axillary nodes should have axillary clearance in principle if it is confirmed by puncture before neoadjuvant treatment. In the 50 years of development of radiation therapy for breast cancer, the same principles of improving efficacy, reducing toxicity, and speed and convenience have been followed. For example, for breast-conserving radiotherapy, the conformal intensity modulation technique nowadays allows the breast to be uniformly irradiated and the surrounding organs to be well protected, and the progress of radiotherapy for breast cancer in the past 50 years is that breast-conserving + radiotherapy replaces total mastectomy, and breast-conserving patients with one or two anterior metastases can no longer undergo axillary clearance. The advances in systemic therapy have led to longer survival and the importance of radiotherapy in comprehensive breast cancer treatment. Advances in systemic treatment of breast cancer The development of categorical diagnosis has led to more targeted treatment of systemic systemic therapy for breast cancer. Advances in chemotherapy have gone from non-anthracycline to anthracycline, to paclitaxel, to new chemotherapeutic agents that still play a very important role in breast cancer clinical practice. Endocrine therapy has gone from the earliest ovariectomy, to adrenalectomy, to tamoxifen, aromatase inhibitors and other drugs used in clinical practice. In postmenopausal endocrine therapy, aromatase inhibitors have become the basic endocrine drugs, mTOR inhibitors combined with endocrine therapy play a role in reversing drug resistance, CD4 and 6 inhibitors in the first line combined with endocrine therapy can improve the efficacy. Anti-HER2 therapy, from trastuzumab, to apatinib, patuximab, and TDM1, clinical studies have demonstrated clinical benefit in HER2-positive patients, so 50 years of clinical progress is not just from improvements in surgical radiotherapy, but more from fine diagnosis and precise classification of treatment, which has seen a decline in mortality. A case treated 10 years ago exemplifies the advancement of treatment in the domestic discipline and the pace of international convergence. The first diagnosis of a Her2-positive patient with liver and bone metastases, surgical resection of the breast followed by chemotherapy combined with targeted and subsequent maintenance therapy, as well as combined local bone radiotherapy, liver interventional chemotherapy, stereotactic brain radiotherapy, and brain surgery according to the progression of the disease, has enabled this advanced HER2-positive patient, who was originally expected to have a very short survival, to now live for over 10 years. The success of this patient’s treatment led us to think about the importance of multidisciplinary and integrated treatment. For a specific patient, drug or surgery first, chemotherapy combined with chemotherapy or targeted therapy, when to start maintenance therapy, how to maintain it, how long to maintain it, and more importantly, the status of the role of local and systemic therapy in controlling the disease in the whole management. The concept of total management of breast cancer that we advocate and promote is to move from a simple patient management to disease management and health management, in order to achieve a common path of fighting cancer between doctors and patients that “once we hold the patient’s hand, we become friends for life”. For breast cancer, the whole management of categorized treatment should be reflected in the different categories of hormone receptor positive, triple negative and HER2 positive patients, and the series of categorized treatment is required to implement the whole management in preoperative neoadjuvant treatment, postoperative adjuvant treatment to prevent recurrence and metastasis, and recurrence and metastasis relief treatment. Nowadays, domestic and international treatment guidelines and expert consensus advocate the rational selection of chemotherapy, endocrine and molecular targeted therapy for different categories of patients, and the selection of appropriate combination or single drug according to the actual situation of patients. Progress of maintenance therapy for advanced breast cancer It is very difficult to cure patients with recurrent metastasis and treatment should be “long lasting and prolonged”. Maintenance therapy is both a clinical need and a management strategy, as achieving and maintaining effective outcomes is a common goal for both physicians and patients. Treatment to disease progression is a new drug clinical research, in order to consider the maximum sustainable duration of the study drugs and programs, to toxicity can not be tolerated to end the study, but patients face the next treatment problem, since it is difficult to cure, should be well maintained, the idea is simple, the approach should not be too complicated. In terms of maintenance therapy, it can be a combination of effective after switching drugs, but this is strictly a backline relief therapy, not strictly maintenance therapy. It can also be to continue the combination therapy after it is effective, but in clinical practice it is many patients who cannot tolerate long-term combination chemotherapy. Another model of maintenance therapy could be monotherapy after effective combination therapy, such as capecitabine-containing combination followed by capecitabine monotherapy maintenance, so that patients who benefit can have longer disease control. data from a national multicenter clinical study of 2000 cases of maintenance therapy for advanced breast cancer organized by CSCO has been collected to look at the clinical benefit of different maintenance strategies in patients with advanced disease after receiving effective therapy. The purpose of the study is to observe the clinical benefit of different maintenance strategies after effective treatment in advanced patients. Advances in postoperative adjuvant therapy for breast cancer Adjuvant therapy for breast cancer has evolved from AC, to TC, to AC-T(H), and selection criteria have now been established. Breast cancer endocrine therapy for postmenopausal receptor-positive patients, aromatase inhibitors can be used initially, switched, or subsequently intensified. Whether and how ovarian suppression is taken in premenopausal patients and for how long. the TEXT and SOFT clinical trials, did address the superiority of AI over tamoxifen under ovarian suppression, a result that may change the clinical trials. To date, the standard of care for premenopausal receptor-positive patients remains triamcinolone for 5-10 years, with some patients having the option of ovarian suppression in combination with tamoxifen and also ovarian suppression in combination with AI, so the appropriate strategy needs to be chosen from an assessment and balance of tolerability and financial considerations for the patient. Anti-HER2 therapy in HER2-positive patients is indeed an influential mind-altering behavior. Expert consensus on HER2-positive breast cancer treatment has also been developed in China. The ALLTO trial gave everyone a big shock because it was indeed a big design involving nearly 10,000 cases at a huge cost, challenging the efficacy of trastuzumab for one year and unfortunately not obtaining such a clinical advantage of lapatinib being superior, with only 60% of patients completing 85% of the trial with lapatinib combined with trastuzumab. Therefore good drugs can be adhered to for a long time to be able to benefit patients, just like endocrine therapy tamoxifen, AI, trastuzumab. As one fellow said, the lack of success of certain treatments in the lung cancer field may be related to this clinical design, as well as drug tolerability. After trastuzumab became the standard for anti-Her-2 therapy, it is also worth thinking about post-trastuzumab therapy. We have compared trastuzumab combined with paclitaxel after failure, lapatinib combined with capecitabine and trastuzumab combined with capecitabine, and got the result that it might be better to change the target drug. But the better drug, TDM1, has surpassed lapatinib in combination with capecitabine. We have seen such a young patient, post-operative adjuvant therapy is not quite standard, after relapse and metastasis relief treatment experienced almost all the guideline recommended chemotherapy drugs, endocrine drugs and targeted drugs, the disease progressed again using TDM1, indeed saw the magic of this drug, two weeks later achieved a good remission, but four cycles later the tumor recurred again. Therefore, the most important thing now is to find out in advance who is primary drug resistant and who is acquired drug resistant, what can reverse the resistance and what can delay the resistance. At present, HER2-positive patients can receive patuximab + trastuzumab + docetaxel internationally, and the second-line treatment is TDM1. but in China, resistance can be switched to lapatinib, and trastuzumab can be continued if there is previous benefit. Of course, we hope that clinical trials for TDM1 can start soon to give more patients more chances. Under the guidance of whole management classification treatment, preoperative patients should be operated, the drug treatment should be drug treatment, patients with relapsed metastasis should not give up, there is hope if they persist, and there will be more chances if they persist, for patients with postoperative adjuvant treatment, don’t slack off and strive for cure.