Background: 1. In 2016, 306,000 breast cancer cases were newly diagnosed in China, with one-third in rural areas. Breast cancer ranked second in incidence (22.47/10⁵) among female cancers in Sichuan Province. 2. Health resources are unequally distributed in China, especially in Sichuan Province where 43.27% reside rurally. County hospitals play a vital role in rural patients' diagnosis, treatment, and referrals. Methods: This cross-sectional observational study surveyed 124 county-level hospitals that had treated breast cancer in 183 counties in Sichuan Province from December 2023 to January 2024. Outcomes include: 1) hospital level; 2) oncology certification; 3) availability of dedicated breast department and staffing; 4) breast cancer diagnosis and treatment technology; 5) pre-treatment TNM staging rate; 6) anti-neoplastic drugs and support Accessibility of medicines. Results: Out of 124 hospitals surveyed, 6 excluded for zero breast cancer cases in 2023. The remaining 118 hospitals revealed: 1) 78.81% tertiary, 93.22% public; 2) 75.42% with special outpatient qualifications, 57.63% with concurrent special antineoplastic drug designations, 17.80% with one qualification; 3) 57.63% with dedicated breast units, but only 16.1% with specialized breast cancer staff; 4) 31.36% with full breast imaging modalities, 78.23% lacking mammography; PET-CT and bone scan availability: 5.93% and 9.32%; 5) 71.19% with independent pathology, but only 30.65% providing comprehensive services; 6) Surgeries for breast cancer: 86.44% (44.07% breast conservation), radiation therapy availability: 39.83%; 7) AJCC TNM staging rate: 77.12%; 8) Antineoplastic accessibility: conventional chemotherapy (93.22%), anti-HER2 therapy (28.81%), endocrine therapy (47.46%), CDK4/6 inhibitors (26.27%, with 41.53% having only one); 9) Analgesics: 87.90% (morphine 94.92%, tramadol 88.98%, fentanyl patches 34.75%, oxycodone 46.61%); antiemetics (5-HT3 antagonists 69.49%, NK1 antagonists 72.88%, olanzapine 48.31%, metoclopramide 64.41%); medications for hematologic toxicity: 51.61%. Conclusions: Shortages exist in specialized breast care units and trained personnel among county hospitals in Sichuan, China. Special outpatient qualifications and antineoplastic prescription credentials concentrated mainly at tertiary centers. Enhancing imaging and histopathology capacities for breast cancer diagnosis is an urgent need. While conventional chemotherapies demonstrate good accessibility, anti-HER2 targeted therapies, endocrine therapies, and CDK4/6 inhibitors covered by national insurance have limited availability. Enhanced provision of new antiemetics and analgesics is needed.