New pharmacologic treatments for early-stage breast cancer have been proven effective, but many of them are cost prohibitive in low economic settings. Differences in breast cancer mortality rates between developed and developing countries may be because of differences in screening and treatment options, some of which may be unavailable or limited by cost constraints in countries with limited resources. It is well recognized that treatment choices have to be made within budgetary constraints, and treatment guidelines that address the need to stratify treatment options by available resources have been published by the Breast Health Global Initiative. Practical treatment choices need to be made based on the best available cost–effective information. This article reviews new and emerging medical strategies that may improve the cost-effectiveness equation. Cancer 2008;113(8 suppl):2353–8. © 2008 American Cancer Society.