Editor's Note: The Chinese Anti-Cancer Association, adhering to the tenet of "prevention, screening, diagnosis, treatment, and rehabilitation," has launched the "Chinese Tumor Integrated Diagnosis and Treatment Guidelines." At the 2024 CACA Integrated Breast Cancer Conference, "Oncology Frontier" invited three authoritative experts from internal medicine, surgery, and radiotherapy—Dr. Man Li from The Second Hospital of Dalian Medical University, Dr. Yingying Xu from The First Hospital of China Medical University, and Dr. Jiayi Chen from Ruijin Hospital, Shanghai JiaoTong University School of Medicine—to discuss the comprehensive management of breast cancer patients under the theme of "Integration for Prevention, Screening, Diagnosis, Treatment, and Rehabilitation." Under the moderation of Dr. Wei Li from Jiangsu Province Hospital, the three experts explored key aspects of comprehensive breast cancer management from personalized treatment, multidisciplinary collaboration, minimally invasive techniques, to new advancements in radiotherapy, providing valuable practical experience and theoretical guidance for future breast cancer management.Dr. Wei Li: The Chinese Anti-Cancer Association, upholding the tenet of “prevention, screening, diagnosis, treatment, and rehabilitation,” has formulated the “Chinese Tumor Integrated Diagnosis and Treatment Guidelines,” the first of its kind in China and the first in the world to propose a comprehensive management system of “prevention, screening, diagnosis, treatment, and rehabilitation.” Our discussion today is based on this content, and we have invited three domestic experts in the field of breast cancer (internal medicine, radiotherapy, and surgery) to analyze patient management from different perspectives.
Firstly, Dr. Man Li, could you discuss from an internal medicine perspective how to balance personalized treatment plans with the “prevention, screening, diagnosis, treatment, and rehabilitation” system to ensure that patients receive precise treatment while fully integrating into the overall process?
Dr. Man Li: I believe the most important aspect of “prevention, screening, diagnosis, treatment, and rehabilitation” is disease diagnosis, and post-diagnosis, the most critical is the treatment. The treatment we choose must be standardized, reflecting whether we provide “personalized treatment” and comprehensive management throughout the disease course. For the overall treatment of breast cancer patients, we increasingly emphasize the importance of the “Little Red Book” (Chinese Anti-Cancer Association’s Breast Cancer Diagnosis and Treatment Guidelines) and the “Little Blue Book” (Chinese Clinical Oncology Association’s Breast Cancer Diagnosis and Treatment Guidelines). These guidelines tell us that standardized treatment is a prerequisite for personalized treatment. Only by following the guidelines can we achieve personalized treatment in clinical practice.
During the standardized treatment of patients, the “Little Red Book” and “Little Blue Book” (guidelines) stratify the treatment of different subtypes of breast cancer patients, providing various treatment recommendations based on these stratifications, ensuring more patients have evidence-based treatment options. In addition to standardized treatment, we also emphasize the importance of comprehensive management, which aligns with the “prevention, screening, diagnosis, treatment, and rehabilitation” philosophy and system. This comprehensive process emphasizes not only prevention and screening but also diagnosis, treatment, and rehabilitation for patients. Recently, the 2024 CACA Integrated Rehabilitation Conference was held in Dalian under the theme “Winning in Integration for Tumor Rehabilitation,” highlighting the importance of collaborative efforts between doctors and patients for rehabilitation. In the future, we must focus on personalized treatment for patients, adhere to standardized treatment according to guidelines, and establish a “prevention, screening, diagnosis, treatment, and rehabilitation” system to guide patients towards recovery.
Dr. Wei Li: Thank you, Dr. Man Li, for your answer. Professor Man emphasized that in the comprehensive management process of “prevention, screening, diagnosis, treatment, and rehabilitation,” standardized treatment is the foundation. Additionally, guidelines lead to standardized treatment for patients.
With the advancement of precision medicine, the role of internal medicine in the comprehensive management of breast cancer is becoming increasingly prominent. First, we invite Dr. Man Li to discuss from an internal medicine perspective what areas need further research or technological innovation to better support this comprehensive management system.
Dr. Man Li: “Winning through integration in tumor prevention and treatment,” and the comprehensive management concept of “prevention, screening, diagnosis, treatment, and rehabilitation” have gradually been integrated into the comprehensive treatment philosophy. The most crucial aspect of this process is precision treatment, which is reflected in both diagnosis and treatment. In recent years, the country has introduced a series of policies to assist in breast cancer prevention and screening. Taking Dalian as an example, the Dalian People’s Government and Dalian Health Commission have launched early screening programs for high-risk breast cancer populations. This initiative has been running for over a year, enabling more women, especially those aged 40 and above, to determine their breast cancer risk through a simple app and receive free mammograms and breast ultrasounds if they are high-risk. Our center’s data shows that among 1,118 high-risk individuals, four patients with small breast tumors were identified, underscoring the importance of screening.
In addition to prevention and screening, it is crucial to provide precision treatment for high-risk populations. Breast cancer subtyping exemplifies precision treatment. For HER2-positive breast cancer, we emphasize anti-HER2 therapy. In patients who have received prior chemotherapy, combining anti-HER2 therapy with chemotherapy provides long-term survival benefits. For HR+ breast cancer patients, the role of CDK4/6 inhibitors is continually rising. For patients progressing on CDK4/6 inhibitors, we need to further screen for different mutation targets, such as choosing different targeted drugs for those with PAM/PI3K/AKT pathway alterations, reflecting precision treatment for HR+ breast cancer. In triple-negative breast cancer, immunotherapy’s role is gradually rising. For PD-L1 high-expression patients, we recommend immunotherapy combined with chemotherapy as first-line treatment, demonstrating precision treatment for this group. From precision diagnosis to precision treatment, we see that precision is central throughout the comprehensive management of patients.
Dr. Wei Li: Dr. Man Li detailed the precision treatment from patient screening to comprehensive treatment, emphasizing its importance. Thank you again, Dr. Man Li.
Dr. Man Li
- Medical Doctor, Professor, Doctoral Supervisor
- Director of Oncology, The Second Hospital of Dalian Medical University
- Liaoning Province Hundred, Thousand, and Ten Thousand Talent Project (Top 100)
- Director of the Chinese Tumor Clinical Society
- Standing Committee Member of the Breast Cancer Expert Committee, Chinese Clinical Oncology Society (CSCO)
- Standing Committee Member of the Breast Cancer Professional Committee, Chinese Anti-Cancer Association
- Deputy Chair of the Tumor Branch of the Liaoning Medical Association
- Deputy Chair of the Breast Cancer Professional Committee, Liaoning Anti-Cancer Association
- Incoming Chair of the Tumor Metastasis Committee, Liaoning Anti-Cancer Association
- Chair of the Tumor Branch, Dalian Medical Association
Dr. Wei Li
- Jiangsu Province Hospital, Department of Oncology
- Doctor, Chief Physician, Associate Professor, Master’s Supervisor
- Member of the Breast Cancer Expert Committee, Chinese Clinical Oncology Society (CSCO)
- Standing Committee Member of the Youth Expert Committee, Chinese Clinical Oncology Society (CSCO)
- Member of the Breast Cancer Professional Committee, Chinese Anti-Cancer Association
- Member of the Tumor Targeted Therapy Professional Committee, Chinese Anti-Cancer Association
- Deputy Chair of the Yangtze River Academic League Breast Cancer Alliance (YBCSG)
- Standing Committee Member of the Tumor Molecular Targeted Therapy Professional Committee, Jiangsu Province Research Hospital
- Member of the Cancer Rehabilitation and Palliative Care Professional Committee, Jiangsu Anti-Cancer Association
- Young Talent of the “Science and Education Prosperity Project” in Jiangsu Province
- Visiting Scholar at the University of South Carolina School of Medicine
