OBJECTIVES: To examine factors associated with the receipt of guideline concordant adjuvant chemotherapy, radiation therapy, and hormonal therapy among women diagnosed with breast cancer. METHODS: The study population consisted of all women residing in a largely rural region of Southwest Georgia diagnosed with a first, primary, invasive early-stage (AJCC stage I, II, and IIIA) breast cancer from 2001-2003. Predictors of guideline-concordant adjuvant therapy, as recommended by the 2000 National Institutes of Health Consensus Development Conference Statement, were examined. Factors associated with receiving guideline concordance with 1) adjuvant chemotherapy; 2) adjuvant radiation therapy; 3) adjuvant hormonal therapy; and 4) all three adjuvant therapies jointly were examined using multivariable logistic regression. The following variables were examined: patient’s age, race, marital status, insurance status, socioeconomic status, urban/rural status, comorbidities, stage at diagnosis, grade, hormonal receptor status, treatment site, distance to treatment site, and type of surgery performed. Multiple imputation was used to estimate missing variable values. RESULTS: Overall, 41% of women were guideline concordant for all three adjuvant therapies jointly. Guideline concordance ranged from 63%-81% for the individual therapies. After adjustment, higher socioeconomic status was associated with guideline concordance for all three adjuvant therapies jointly (odds ratio [OR], 3.13, 95% CI, 1.27-7.71), and chemotherapy (OR, 3.13, 95% CI, 1.04-9.42) and Medicaid insurance was associated with guideline concordant chemotherapy (OR, 4.09; 95% CI, 1.50-11.20). Being unmarried was associated with nonguideline concordant chemotherapy (OR, 0.44; 95% CI, 0.22-0.85) and radiation therapy (OR, 0.47; 95% CI, 0.26-0.83). Increased age predicted nonguideline concordance for all three adjuvant therapies jointly, chemotherapy, and radiation therapy. The results were robust to the use of multiple imputation. CONCLUSIONS: Patient age, socioeconomic status, and marital status were independently associated with receiving guideline concordant adjuvant therapy. Identifying and addressing modifiable factors that lead to non-guideline concordant treatment may reduce disparities in treatment and improve cancer outcomes.