One of the most important factors that have led to the modern management of primary breast cancer has been the acceptance of the fact that the natural history of the disease is associated with early systemic dissemination, treatment failure and death (1). This led in the 1950's and 1960's to the realisation of the need for systemic therapy in conjunction with the local therapy of the cancer either by surgical resection with or without radiation therapy. This type of chemotherapy, which is administered in the absence of overt manifestation of disseminated cancer, is referred to as adjuvant chemotherapy. The rationale for the development of this type of treatment modality was based on observations that disseminated tumour cells in experimental animals could be destroyed with systemically administered chemotherapeutic agents (2-4). © 2006 Springer.