Chemotherapy can be an integral component of the adjuvant management strategy for women with early-stage breast cancer. Modern adjuvant strategies now comprises one or more chemotherapy agents, hormonal maneuvers, immunotherapy agents, or experimental agents. The use of adjuvant chemotherapy is generally based on estimates of an individual's risk of recurrence and the expected benefit of therapy. However, risk-benefit calculations have recently become increasingly sophisticated as a result of advances in genetic testing and molecular marker identification as well as ongoing refinements in chemotherapy strategies. In this article we will review the role of important prognostic and predictive factors and the rationale for adjuvant systemic therapy and modern chemotherapy regimens in the management of women with early-stage breast cancer.