Editor's Note: The 19th National Breast Cancer Academic Conference and the 21st Shanghai International Breast Cancer Symposium (SIBCS) were successfully held on October 16–17. Under the theme “Building on Solid Foundations and Navigating with Precision,” this year's meeting focused on advances in breast cancer diagnosis and treatment. At the conference, Professor Shusen Wang of the Breast Cancer Prevention and Treatment Center, Sun Yat-sen University Cancer Center, served as an expert in the late-stage disease section of the Chinese Anti-Cancer Association Guidelines and Standards for Breast Cancer Diagnosis and Treatment. He joined fellow experts in analyzing, reviewing, and discussing challenging cases of advanced breast cancer. Against this background, Oncology Frontier invited Professor Wang to share his insights on patient selection and key clinical decision-making, the integration of treatment recommendations in clinical guidelines with individualized care, and the challenges and potential pathways for implementing guidelines in routine practice.01
Oncology Frontier: As an expert responsible for guiding the discussion of advanced breast cancer cases in the Chinese Anti-Cancer Association Guidelines and Standards for Breast Cancer Diagnosis and Treatment, could you first explain what key decision-making points you hoped to highlight through these cases? What criteria do you use when selecting cases?
Professor Shusen Wang: At the 2026 SIBCS conference, I served as an expert discussing cases of advanced breast cancer under the Chinese Anti-Cancer Association Guidelines and Standards for Breast Cancer Diagnosis and Treatment. I led the audience through the analysis, review, and discussion of these cases.
When selecting cases, I focused on several aspects. First, I wanted to emphasize the principles of breast cancer classification and stratified treatment. Accordingly, I selected three cases representing different subtypes: HER2-positive advanced breast cancer, HR-positive/HER2-negative advanced breast cancer, and triple-negative advanced breast cancer. Breast cancer encompasses multiple subtypes, so classification must be the starting point for treatment. The treatment decision-making process for each patient should also reflect the principle of stratified care, including the selection of first-line, second-line, and subsequent treatment options. These are key principles emphasized by the guidelines.
In addition, I wanted the case discussions to focus on specific treatment decisions, the key recommendations in the 2026 edition of the Chinese Anti-Cancer Association Guidelines and Standards for Breast Cancer Diagnosis and Treatment, and the changes introduced compared with previous editions. By aligning these updates with each patient’s treatment course, we could conduct a more relevant and detailed case analysis.
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Oncology Frontier: Through this case-based discussion and expert commentary, how can clinicians strike a balance between guideline-based, standardized treatment and individualized care when selecting medications for patients?
Professor Shusen Wang: Guidelines and standards must be translated into clinical practice. This ultimately comes down to making treatment decisions for individual patients. When selecting medications, clinicians must be thoroughly familiar with each drug’s place in the guidelines, the supporting clinical evidence, and the specific clinical scenarios in which its use is recommended.
During treatment, the first step is to place each patient in the appropriate clinical context. For example, for a patient with HR-positive/HER2-negative advanced breast cancer, clinicians should first understand the stage of the disease, whether the patient has received endocrine therapy, and whether the disease has responded to previous treatments. Based on these factors, patients can be appropriately classified and treated.
Therefore, truly appropriate medication selection requires both a sound understanding of the guidelines and their practical application to each patient’s specific clinical circumstances. These two elements must be integrated. In addition, treatment selection should take into account efficacy, adverse effects, and the patient’s financial capacity. In short, when prescribing medications for individual patients, clinicians must consider not only guideline recommendations but also multiple aspects of individualized care.
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Oncology Frontier: For primary care physicians, where do the greatest challenges lie in implementing guidelines for advanced breast cancer? Through these case discussions, what practical and reproducible clinical pathways do you hope to offer primary care settings?
Professor Shusen Wang: China is a vast country with a large number of medical institutions. From the perspective of patient care, a considerable proportion of patients continue to receive treatment at primary care institutions. However, recommendations for diagnosis and treatment are continually evolving as new clinical evidence emerges. Consequently, primary care physicians and institutions face real challenges in applying guidelines consistently and appropriately. These challenges include the availability of medications, access to imaging equipment and genetic testing, and whether the necessary multidisciplinary specialists are available.
Developing a treatment plan requires more than an oncologist alone. Pathologists, radiologists, and other specialists must also participate in multidisciplinary discussions. Many primary care hospitals lack a complete multidisciplinary team, which limits their ability to provide comprehensive care and makes guideline implementation more challenging.
Nevertheless, primary care physicians can use guidelines and participate in relevant academic activities to develop a sound understanding of the available treatment pathways. For example, they should understand the principles of treatment selection and the circumstances in which different approaches are appropriate, enabling them to make informed decisions about which treatment pathway to follow. Even when clinical practice is constrained by limited resources or other special circumstances, physicians can seek appropriate solutions and adjustments.
Today, many hospitals can access medical support through online consultations and remote multidisciplinary discussions. National academic societies also organize educational activities for primary care physicians. Clinicians should make full use of these opportunities to strengthen their understanding of guidelines and the evidence supporting them, while also drawing on external resources and considering the realities of their local clinical settings.
Ultimately, primary care physicians face many challenges when making treatment decisions, particularly when tailoring treatment to individual patients. However, with a solid theoretical foundation and the appropriate preparation described above, they can provide more effective and individualized treatment for patients in primary care settings.
Professor Shusen Wang
