Editor's Note: At the end of 2024, the 2025 Essentials of CBCS & CSOBO Breast Cancer Diagnosis and Treatment Guidelines (hereafter referred to as the "New Little Red Book") was officially released during the 16th Shanghai Breast Cancer Symposium and Annual Meeting of the Shanghai Anti-Cancer Association Breast Cancer Committee. This updated edition provides fresh guidance for clinical breast cancer practices.During the launch event, Oncology Frontier interviewed several renowned experts, including Professor Guangyu Liu from Fudan University Shanghai Cancer Center, Professor Li Ma from The Fourth Hospital of Hebei Medical University, Professor Yongsheng Wang from Shandong Cancer Hospital, Professor Yingying Xu from The First Hospital of China Medical University, and Professor Benlong Yang from Fudan University Shanghai Cancer Center (listed alphabetically by surname). They shared insights into the new features of the guidelines, their practical applications, their impact on clinical practice, and the surgical updates they found most noteworthy.
Key Updates:
- The New Little Red Book provides detailed recommendations for de-escalation treatment of axillary lymph nodes following neoadjuvant therapy, supported by the latest evidence-based findings.
- It introduces guidance to exempt patients with isolated tumor cells (ITC) in lymph nodes post-neoadjuvant therapy from axillary lymph node dissection, with optional axillary radiotherapy.
Reflections:
- The updates on ITC are particularly beneficial for patients whose frozen intraoperative pathology shows no metastasis, but postoperative paraffin pathology reveals ITC. These patients can now bypass axillary dissection, significantly reducing the risk of upper limb complications.
- The guidelines align with the global trend toward de-escalation in surgical treatment while incorporating recommendations tailored to China’s clinical realities.
- The New Little Red Book is user-friendly, available in handbook and mobile app formats, and now includes scannable QR codes linked to evidence-based references. Professor Liu hopes younger doctors will enhance its accessibility for grassroots practitioners, making it easier to understand and apply.
Reflections:
- The New Little Red Book stands out for its scientific rigor, authority, and practicality, earning widespread recognition.
- It features a concise and clear structure, emphasizing core concepts and key steps.
- By incorporating multimedia elements, such as QR codes for surgical videos, it makes learning more engaging.
- The guidelines emphasize evidence-based medicine, updated annually to stay at the forefront of international research, ensuring scientific validity.
- Practical tools like adverse reaction management cards and chemotherapy dosage calculators have been added.
- This edition represents the advent of the “3.0 era” in breast cancer diagnosis and treatment, with its most notable feature being the inclusion of more Chinese research and insights, directly benefiting patients in China.
- The New Little Red Book is a culmination of expertise in the field, serving as a beginner’s guide for young doctors and a practical resource for seasoned clinicians, ultimately helping improve patient outcomes.
Key Updates:
- The guidelines introduce a nomogram (with QR code) to predict the probability of non-sentinel lymph node positivity in cN0 patients undergoing regional lymph node biopsy and treatment.
Reflections:
- While this update has limited immediate impact on clinical practice, it holds significant research value. The nomogram can help design experiments to predict non-sentinel lymph node positivity, potentially leading to more precise management strategies in the future. This includes avoiding unnecessary dissection and optimizing adjuvant radiotherapy and systemic treatment approaches.
Reflections:
- The New Little Red Book has profoundly influenced clinical breast cancer practices nationwide, becoming an indispensable reference for physicians.
- Its annual updates ensure that content remains aligned with the latest medical advancements, enabling clinicians to keep pace with evolving treatment paradigms. The associated roadshows also help young physicians grasp the essence of the guidelines.
- Balancing drug accessibility with the latest clinical trial results, the guidelines provide practical and cutting-edge recommendations that serve as a precise guide for clinical application while also offering insights into the latest advancements.
Key Updates:
- The concept of conservative total mastectomy has been introduced. Originally proposed by Professor Jiong Wu on a national scale, this includes skin-sparing mastectomy (SSM), nipple-sparing mastectomy (NSM), and skin-reducing mastectomy (SRM).
- Conservative total mastectomy is comparable to traditional mastectomy in oncological safety but reduces the complexity of subsequent breast reconstruction while improving aesthetic outcomes.
- Updates to oncoplastic breast surgery (OPS) include a revised decision-making flowchart and the addition of volume replacement flap techniques.
- Chapters on autologous flap breast reconstruction and implant-based reconstruction classification have been added.
Reflections:
- The New Little Red Book’s greatest strength lies in distilling the essence of the guidelines into a portable reference, available as a pocketbook, mini-program, and web version, making clinical application highly convenient.
- Every recommendation is supported by corresponding evidence-based data, ensuring its credibility.
- By providing clear and precise treatment pathways, the book offers grassroots doctors efficient guidance and has earned widespread trust and popularity.
- Professor Yang envisions future iterations integrating AI and big data technologies to further streamline clinical applications and enhance accessibility for daily use.
The 2025 Essentials of CBCS & CSOBO Breast Cancer Diagnosis and Treatment Guidelines embodies the collective wisdom of leading experts in the field. This authoritative and user-friendly guide offers practical tools, evidence-based recommendations, and cutting-edge insights to support clinicians in providing better care for breast cancer patients in China and beyond.
