The 41st San Antonio Breast Cancer Symposium was held in San Antonio, Texas, USA on December 4-8, 2018. In this article, we reviewed the key advancement in breast cancer surgery, chemotherapy, targeted therapy, immunotherapy and endocrine therapy reported in this symposium, in order to provide references for clinicians in the treatment and research of breast cancer. The 10-year follow-up data of the EORTC AMAROS study suggested that axillary radiotherapy was a safe and feasible alternative to axillary lymph node dissection for primary breast cancer patients with positive axillary lymph nodes confirmed by sentinel lymph node biopsy. The result of the phase 3 GEICAM/CIBOMA study showed that in early triple negative breast cancer patients, capecitabine administration after surgery and standard chemotherapy did not significantly improve the patients’ survival. The meta-analysis conducted by researchers in Harvard University suggested that the patients who achieve pCR after neoadjuvant chemotherapy could be exempted from conventional adjuvant chemotherapy, with no obvious effect on patients’ survival. The multi-center PEONY study conducted by Professor Shao Zhimin in China showed that for neoadjuvant therapy of early or locally advanced HER-2 positive breast cancer patients in Asia, the overall postoperative pCR rate of double-target group (pertuzumab monoclonal antibody + trastuzumab monoclonal antibody + docetaxel) was significantly higher than that of single-target group (trastuzumab monoclonal antibody + docetaxel). The KATHERINE study showed that the trastuzumab monoclonal antibody combined with maitansine conjugate was feasible in the adjuvant treatment of HER-2 positive early breast cancer. An exploratory analysis to evaluate the efficacy of immuno-biomarker subgroups in the IMpassion 130 study showed that the patients with programmed death ligand 1 positive in immunocytes significantly benefited from the treatment of atezolizumab monoclonal antibody + albumin paclitaxel. The PALLET study showed that in postmenopausal early breast cancer patients with ER positive and HER-2 negative, the neoadjuvant endocrine therapy of letrozole combined with CDK4/6 inhibitors significantly increased the inhibition rate of Ki67, but did not improve the clinical response rate. The 10-year clinical data of the AERAS study showed that the patients significantly benefited from the adjuvant endocrine therapy if the use of anastrozole was extended to 10 years. The meta-analysis of EBCTCG showed that prolonged endocrine therapy significantly reduced the overall risk of recurrence in hormone receptor-positive postmenopausal breast cancer. The TAM-01 study suggested that low-dose administration of tamoxifen could reduce the toxicity and improve the efficacy in patients with breast intraductal neoplasms. The clinicians should actively promote the clinical research of new drugs and the exploratory analysis of predictive biomarkers, take the advantages of domestic researches and learn advanced techniques and concepts overseas in order to benefit most of breast cancer patients.