The recently concluded San Antonio meeting featured several studies that were controversial or that overturned previous treatment concepts. For this reason, a number of studies were discussed by experts in the field of breast cancer at the recent San Antonio Essence Symposium. One of the most heated discussions was a study on the need for local treatment of stage IV breast cancer. Professor Jiang Zefei, chairman of the conference, began by highlighting the following: First, going back to the basic information about the patients enrolled in the study, the study released in this Antonio meeting is for patients with clinical stage 4, which refers to patients with stage 4 at the first diagnosis, not patients with recurrent metastases after treatment, which is a very important issue to clarify. Secondly, there is no evidence that “resection of the primary site will promote metastasis”. It is not possible to completely abandon surgical treatment based on such a study result alone. Another conference chairman, Prof. Liu Yinhua, said: The so-called TNM stage refers to the clinical stage before treatment. Some patients with a large primary tumor load at diagnosis need to receive systemic therapy, and the main role of surgical treatment is in improving the patient’s well-being, not prolonging survival; likewise, the patient’s prognosis is not only determined by the patient’s stage. Clinicians need to do what can be done and do what makes sense. The decision of how to treat the first diagnosis of stage 4 needs to be thought through before making a decision. Other experts at the meeting also said that in previous studies reported that patients with metastatic breast cancer can benefit in terms of survival when the primary site is removed when conditions allow, and although there is no statistical difference, survival time is still prolonged. Most notably, patients in the resected group showed a significant improvement in subjective perception during follow-up compared to those in the unresected group. Therefore, it is believed that a positive attitude should be taken towards the patient’s primary site resection situation, but it should not be blinded to the fact that this does not allow the patient to benefit when the conditions are not ripe for creation. Stage 4 breast cancer actually includes many classifications, and the situation of metastases (whether single or multi-organ, single or multiple) is different and should be treated differently. If the metastasis is only a single isolated lesion and the tumor has been stabilized or shrunk after receiving prior treatment, the localized lesion can still be managed. Therefore, it is highly undesirable or even dangerous to change clinical practice based on the results of one study at the time of rapid development of clinical diagnosis and treatment of tumors. Clinicians need to decide the treatment plan for patients based on what has been fully authenticated in guidelines and consensus, and also based on the specific conditions of patients, rather than easily dismissing the current clinical practice because of some study results.