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The choice of patients with an expected aggressive course of the disease who need adjuvant systemic therapy while others can be spared the adverse effects of such therapy represents one of the main challenges of early stage breast cancer treatment. Prognostic factors, such as lymph node status, tumour size, grade, lymphovascular invasion, patient age, hormone receptor status, human epidermal growth factor receptor 2 status, antigen Ki-67, and the proteases urokinase plasminogen activator and plasminogen activator inhibitor 1, are used to guide this decision. Guidelines and computer applications incorporating the most important prognostic factors are very helpful. In the future, we expect to be able to get even more detailed information from genetic profiling.