Early-stage breast cancer is a highly curable disease with well-established protocols, including surgery, and the adjuvant modalities of regional radiation therapy, chemotherapy, and hormonal therapy. Yet, there is clear evidence that these adjuvant modalities are underused significantly. This article reviews the evidence that supports the use of efficacious local and systemic therapies in early-stage breast cancer, reasons for underuse, and interventions that have proven to be effective in ensuring the delivery of appropriate breast cancer care and suggests strategies to improve the quality of breast cancer care.