Breast cancers are considered as early operable if there is clinically no extension of the primary tumor/axillary lymph node disease to skin/chest wall or in the absence of extra-axillary nodes.The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. The St. Gallen Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics & patient comorbidities.Historically, the DBCG 77B trial demonstrates that oral single-agent cyclophosphamide significantly reduces the risk of recurrence and mortality as compared with no systemic therapy in pre-menopausal patients with high-risk early stage breast cancer. While DBCG 89D trial showed an incremental benefit in DFS and OS from substituting methotrexate with epirubicin in the classic CMF protocol.