Jean-Yves Pierga, MD, PhD, Institut Curie, Paris, France, talks on the major topics discussed at the St. Gallen International Breast Cancer Consensus Session 2021. One major talking point was the use of genomic predictors to determinine the need for adjuvant chemotherapy in hormone receptor-positive disease, with questions remaining unanswered in the pre-menopausal setting. The proportion of chemotherapy effect attributable to ovarian function suppression rather than intrinsic treatment effects in these patients was also debated. Dr Pierga also highlights oligometastatic disease, tumor size thresholds for systemic therapy, and changing standards in radiotherapy as topics of interest at this year’s meeting.