Just as the NSABP B-04 and B-06 trials have advanced our understanding of the survival impact of surgical therapy of breast cancer over the past 25 years, the current international clinical trials underway through NSABP and ACOSOG offer similar hope for improved treatment of the patient with breast carcinoma. Information from these three trials will offer: (1) survival data on sentinel node negative patients who undergo no further axillary therapy; (2) prognostic information on the importance of IHC positive sentinel lymph nodes and ICC positive bone marrow, which will lead to further studies on selective distribution of adjuvant chemo-hormonal therapy; and (3) survival data on sentinel node-positive patients who undergo no further axillary therapy. In keeping with past successes, the continued participation of surgeons in clinical trials contributes to the advancement of evidence-based therapeutic strategies for patients diagnosed with breast cancer.