Neoadjuvant chemotherapy (NAC) is being used with increasing frequency in the multidisciplinary care of women with breast cancer. NAC can increase the chances for successful breast conservation and may decrease the need for axillary node dissection in selected patients. Some patients with chemoresistant tumors may benefit more from hormonal neoadjuvant therapy. The greatest potential for this approach is to predict responses of different breast cancers to therapy based on molecular profiles. This will accelerate better understanding of breast cancer biology and progress toward improved and more individualized therapy.