Breast cancer used to be perceived as a stigmatized disease and rates of early diagnosis were poor because women were often reluctant to present to their physician. Once a diagnosis had been made, there was no adjuvant therapy and little in the way of palliative treatment for advanced disease. Fortunately, the situation today is much improved and although breast cancer remains the most common from of cancer in women, changing attitudes have helped to ensure improved awareness and earlier presentation of patients, leading to earlier diagnosis and better prognosis. Improved detection and treatment regimes have begun to impact on breast cancer mortality; important long-term treatment goals include the prevention of both disease recurrence and the development of advanced disease. This will necessitate improvements in systemic therapies based on the biological properties of the tumor rather than relying on early diagnosis and chemo-prevention. Significant progress has been made over the last 30 years, and the future of breast cancer treatment should be faced with optimism.