Systematic adjuvant therapy has improved the outcome for women with operable breast cancer. As a result, a substantial proportion of patients with this disease are candidates for adjuvant treatment. In providing a woman with recommendations for therapy, her risk of developing recurrent breast cancer needs to be assessed in relationship to the degree of benefit she will obtain from treatment. With the range of presently available treatments, an individualized approach is necessary to provide the patient with options appropriate for her own situation. For women with a high risk of recurrence despite current standard adjuvant therapies, innovative approaches with high dose chemotherapy followed by infusion of autologous hematopoietic stem cells and growth factors are being evaluated. Ongoing clinical trials will demonstrate whether or not these newer therapies result in a better outcome.