Editor’s Note: Facing the global challenge of breast cancer in women’s health, China is advancing the standardization and quality control of breast cancer diagnosis and treatment with unprecedented determination. At the recent 2024 Straits Breast Cancer Forum and the Annual Meeting of the Breast Disease Branch of the Fujian Medical Association, Oncology Frontier invited Dr. Fei Ma, Vice Chair and Secretary-General of the Breast Cancer Committee of the National Cancer Quality Control Center and a leading expert from the National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences. Professor Ma shared insights into the significant progress China has made in improving standardized breast cancer treatment and reducing disparities between urban and rural areas. He also discussed future directions for breast cancer quality control initiatives.

Oncology Frontier: Dr. Fei Ma, in your speeches and reports, you have emphasized the importance of breast cancer quality control as a critical step toward achieving the Healthy China 2030 goals. Could you elaborate on how quality control in breast cancer specifically helps improve overall survival rates and the quality of life for breast cancer patients in China? Additionally, which key factors or stages in quality control are essential to achieving this goal?

Dr. Fei Ma: Breast cancer is the most common malignancy among women in China and globally, making its prevention and treatment crucial for cancer control worldwide. When comparing breast cancer diagnosis and treatment outcomes between China and other countries, a noticeable gap exists. Specifically, China’s overall five-year survival rate for breast cancer patients is 7–8 percentage points lower than that of Europe and the United States, highlighting areas where we must focus our efforts.

Additionally, China’s vast geography leads to significant regional and urban-rural disparities in breast cancer diagnosis, treatment outcomes, and survival rates. For example, the five-year survival rate for breast cancer in rural areas is at least 20 percentage points lower than in urban areas, underscoring the urgency of addressing this issue.

Importantly, as treatment options for breast cancer continue to evolve, more patients are achieving long-term survival with cancer. Breast cancer survivors now make up the largest group among all cancer survivors. Therefore, improving survival rates and enhancing the quality of life for these patients are equally vital goals.

To tackle these challenges, we have focused on several key areas in breast cancer prevention and control. First, in clinical care, we have strengthened multidisciplinary standardized diagnosis and treatment. By enhancing the capabilities of pathology, imaging, surgery, internal medicine, and radiotherapy departments, we aim to improve breast cancer treatment outcomes.

Second, during the post-treatment phase, we strive to improve both survival and quality of life for patients. This requires shifting from a disease-centered to a patient-centered care model, holistically addressing patients’ treatment needs and health risks.

Finally, a major bottleneck in improving China’s overall five-year survival rate is the low rate of early diagnosis. To address this, we must push breast cancer prevention and control further upstream by strengthening screening and early diagnosis for high-risk populations. Additionally, we need to increase public awareness and scientific literacy regarding breast cancer prevention to control the rising incidence of the disease.

Standardized diagnosis and treatment quality control are vital tools in this process. Through updating clinical guidelines, building quality control systems, and establishing pilot centers, we are steadily advancing breast cancer quality control efforts.

Oncology Frontier: In the China Breast Cancer Standardized Diagnosis and Treatment Quality Control Report, you mentioned that quality control work not only focuses on standardizing the diagnostic and treatment process but also aims to reduce urban-rural and regional disparities. What specific achievements have been made in this regard? What future strategies and measures will further promote the distribution of high-quality medical resources to ensure that more grassroots patients receive high-quality breast cancer care?

Dr. Fei Ma: Since the Chinese government decided in 2018 to promote standardized cancer diagnosis and treatment, breast cancer was selected as the pilot cancer type for this initiative. In August 2018, the first national-level Breast Cancer Quality Control Expert Committee was established under the National Cancer Quality Control Center. Over the past five years, we have made significant progress in standardizing breast cancer diagnosis and treatment.

First, we have improved a comprehensive guideline system led by national health authorities with administrative oversight. This system includes guidelines from the National Health Commission, the Rational Drug Use Committee, the National Cancer Center, and the National Cancer Quality Control Center, covering screening and early diagnosis, standardized treatment, rational medication, late-stage treatment, and county-level diagnosis and treatment. These guidelines are regularly updated to stay current. For example, in 2023, we updated the Breast Cancer Rational Drug Use Guidelines (2nd Edition) and this year, we revised the China Guidelines for the Standardized Diagnosis and Treatment of Advanced Breast Cancer (2024 Edition).

Second, we have established a robust breast cancer standardized diagnosis and treatment quality control system. This involves both organizational and disciplinary quality control. Organizationally, besides forming a national expert committee, we have set up provincial-level breast cancer quality control committees in 24 provinces, with more in progress. Disciplinarily, we have developed quality control systems across seven sub-disciplines: ultrasound diagnosis, radiological diagnosis, pathological diagnosis, surgical treatment, medical treatment, radiotherapy, and pharmaceutical quality control.

Third, we have completed the selection, construction, evaluation, and continuous development of pilot centers across the country. Since 2020, we have designated the first batch of pilot centers, covering 30 provinces and 200 medical institutions. After years of capacity building, we began the first phase of evaluations last year and have now started selecting and developing the second batch of pilot centers. Through these pilot centers, we aim to expand and elevate the national breast cancer diagnosis and treatment system.

Fourth, breast cancer has pioneered quality control as a model. After the initial success of the breast cancer pilot program in 2021, China expanded standardized diagnosis and treatment quality control to 17 common malignant tumors nationwide. This expansion was based on the breast cancer pilot model, significantly contributing to the advancement of the entire cancer prevention and control system.

Moving forward, we will continue to strengthen quality control systems, improve the distribution of high-quality medical resources, and ensure that patients across all regions—especially in grassroots and rural areas—can access standardized and effective breast cancer care.

Oncology Frontier: With the continuous advancement of medical technology and the emergence of new treatments, breast cancer quality control faces both new challenges and opportunities. How do you balance the application of traditional treatments and emerging technologies to ensure patients receive safe, effective, and personalized care? Additionally, what are your expectations and plans for the future of breast cancer quality control?

Dr. Fei Ma: Throughout the development of standardized diagnosis and treatment quality control for breast cancer, as well as in broader cancer prevention and control, we have consistently regarded “standardization” and “innovation” as two fundamental pillars.

Standardization ensures that mature, evidence-based medical practices are appropriately applied to patients. This approach enhances the consistency and quality of breast cancer care, allowing patients to access standardized, high-quality medical services close to home. This is the core value of promoting standardized diagnosis and treatment quality control.

However, standardization only brings our care to an average or satisfactory level—perhaps even good—but not yet excellent. To continuously improve treatment outcomes, we must pursue innovation. This involves leveraging scientific and technological advancements, fostering interdisciplinary collaboration, and integrating cross-specialty expertise to enhance the overall quality of breast cancer care. We need to develop more innovative drugs, advance new diagnostic and treatment systems, and create more advanced medical devices and equipment to improve treatment efficacy.

At the same time, we aim to transition from a disease-centered model to a patient-centered model. This means pushing prevention and control efforts further upstream by introducing innovative screening strategies to increase early detection rates and implementing scientific prevention methods to lower cancer incidence. Only then can we minimize the overall impact of cancer on patients.

Therefore, we must progress by balancing standardization and innovation. Today’s innovative treatments could become tomorrow’s standard care. By integrating both approaches, we continuously elevate the quality of diagnosis and treatment, ensuring steady improvements across the board.

Looking ahead, we plan to focus on the following aspects to advance standardized breast cancer care:

1. Strengthening Grassroots Prevention and Control Systems: Currently, over 30% of breast cancer cases occur in areas below the county level, where the five-year survival rate is at least 20 percentage points lower than in urban areas. To address this disparity and rapidly improve cancer prevention and control at the grassroots level, we have established a four-tiered cancer prevention and control system at the national, provincial, municipal, and county levels. Moving forward, we will continue to enhance and expand this system.
2. Expanding Access to Quality Medical Resources: We will promote the distribution of high-quality medical resources through the development of national and regional medical centers and by implementing a hierarchical diagnosis and treatment system. Additionally, we will harness emerging technologies such as big data, the internet, and artificial intelligence to expand and distribute quality medical resources. This will help us better meet the diagnostic and treatment needs of grassroots patients and improve their quality of life.
3. Advancing Broader Cancer Prevention Efforts: We aim to use our progress in breast cancer prevention and control as a model for other cancers. By sharing our experiences and successful practices, we hope to drive improvements in the prevention and treatment of other solid tumors. Furthermore, we intend to share China’s breast cancer prevention experience with the global community, contributing to the worldwide effort against breast cancer.

Dr. Fei Ma

• Chief Physician, Professor, Doctoral Supervisor, Distinguished Professor of the Changjiang Scholars Program
• Director, Department of Medical Oncology, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences
• Secretary-General, National Committee for Clinical Use Monitoring of Antitumor Drugs
• Vice Chair, Breast Cancer Committee, National Cancer Quality Control Center
• Secretary-General, Breast Cancer Screening and Early Diagnosis and Treatment Committee, National Cancer Center
• Expert, Healthy China Initiative Promotion Committee
• Vice Chair, Oncology Pharmacy Committee, Chinese Pharmacists Association
• Vice Chair, Cardio-Oncology Integration Committee, Chinese Anti-Cancer Association
• Vice Chair, Multiple Primary and Cancer of Unknown Primary Committee, Chinese Anti-Cancer Association
• Secretary-General, Clinical Research Committee on Antitumor Drugs, Chinese Anti-Cancer Association
• Vice Chair, National Women’s Ovarian Protection and Anti-Aging Promotion Committee
• Secretary-General, Geriatric Oncology Division, Chinese Geriatrics Society
• Vice Chair, Beijing Breast Disease Prevention and Treatment Association
• Chair, Chemotherapy Quality Control Committee, Beijing Cancer Treatment Quality Control and Improvement Center
• Editor-in-Chief, Cancer Innovation
• Recipient of the Second Prize of the National Science and Technology Progress Award, recognized as one of the Top Ten Outstanding Young Physicians in Beijing, and awarded the China Cancer Young Scientist Award