Systemic adjuvant treatment is an integral component in the treatment of women with early-stage breast cancer and contributes significantly to the reduction of breast cancer-specific mortality. Decisions regarding adjuvant treatment modalities are becoming increasingly complex and demand individualised risk assessments based not only on clinicopathological criteria such as tumour size and axillary lymph node status but also on molecular predictors of the biological behaviour of the cancer. In addition, with the development of targeted therapies targeting HER-2 and with the availability of third generation aromatase inhibitors, new therapeutic options are available and need to be integrated into the treatment algorithms. In this review, we discuss the guidelines and recommendations concerning adjuvant systemic treatment of early-stage breast cancer based on current risk classifications.