Current status of breast cancer diagnosis and treatment capacity in county-level medical institutions in Sichuan Province, China: a cross-sectional study.

Objective: To evaluate the current capacity for breast cancer diagnosis and treatment in county-level medical institutions in Sichuan Province, China. Methods: This cross-sectional observational study was conducted between December 2023 and January 2024. A retrospective questionnaire was administered to 124 county-level medical institutions in Sichuan Province that reported providing breast cancer services. Survey domains included hospital grade and ownership, oncology accreditation, breast specialty section/group setup and staffing, breast cancer diagnostic and therapeutic techniques, AJCC TNM staging documentation rates, and access to antineoplastic and palliative care agents. Data were analyzed using descriptive statistics with SPSS version 22.0. Results: Of 124 institutions surveyed, six were excluded because they had not treated any breast cancer patients in 2023, leaving 118 for analysis. Tertiary hospitals accounted for 78.81% and public hospitals for 94.07%. 75.42% of institutions held qualifications for special outpatient services, while 57.63% possessed both recognition for special antineoplastic drugs and prescribing authority. An independent breast specialty section/group existed in 57.63% of institutions, but only 16.95% were equipped with a comprehensive multidisciplinary team. Simultaneous availability of breast ultrasound, CT, MRI, and mammography was reported by 33.90%; PET-CT and bone scintigraphy were available in 7.63% and 11.02%, respectively. Independent pathology departments existed in 71.19% of cases. Breast cancer surgery was performed in 86.44% of institutions and breast-conserving surgery in 44.07%; The radiotherapy provision rate was 38.98%. The AJCC TNM staging rate was 77.12%. Complete availability rates for conventional chemotherapy agents, anti-HER2 targeted therapies, endocrine agents, and CDK4/6 inhibitors were 33.90%, 22.88%, 47.46%, and 10.17%, respectively. Strong opioids for pain control and several key antiemetics showed variable accessibility. Conclusions: Breast cancer diagnostic and treatment capacity in county-level hospitals in Sichuan Province remains limited, reflecting common challenges in low- and middle-income countries (LMICs). Key deficiencies include underdeveloped dedicated breast oncology units, insufficient specialized personnel, restricted access to advanced imaging and innovative therapies (especially CDK4/6 inhibitors and anti-HER2 agents), and suboptimal availability of strong opioids and novel antiemetics for palliative care. Targeted policy interventions are needed to strengthen infrastructure, workforce, and drug accessibility at the county level. These findings provide valuable insights for improving breast cancer care in other resource-constrained settings globally.