Recent data reveal that within HR+ HER2- early breast cancer patients who are node-negative (N0), a significant subgroup faces high risk of recurrence due to factors such as larger tumor size, higher grade, elevated Ki-67, or unfavorable genomic profiles. These high-risk N0 patients have outcomes similar to those with N1 disease, highlighting the need for greater clinical attention. Ongoing clinical trials and research initiatives are actively exploring new strategies to address this unmet need, aiming to improve patient outcomes in the future.