1 cm in size node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion - high nuclear grade - high histological grade - HER 2/neu overexpression - negative hormone receptor status Adjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive. The use of chemotherapy in post-menopausal women is controversial. - In post menopausal women, chemotherapy is frequently used upto age 70 yrs, if she can tolerate it. - In older women, chemotherapy is performed less frequently. - In estrogen positive tumors, in postmenopausal women, antiestrogen (tamoxifen/ aromatase inhibitors) therapy is the preferred form of adjuvant systemic treatment. Neoadjuvant chemotherapy - it involves the administration of adjuvant therapy before primary therapy (surgery & radiation therapy) - it has shown to down-stage the tumor.">