We aimed to investigate risk factors of local and distant recurrence in small-sized, node negative breast cancer in women <35 years in a Chinese cohort. Between January 1994 and January 2007, 107 patients with pathologically confirmed small-sized (1cm), node negative breast cancer who did not receive neoadjuvant or adjuvant chemotherapy were included. The 5-year recurrence-free survival (RFS) was estimated according to different prognostic variables. With a median time of 60 months (range, 8-60 months) follow-up, local and distant recurrence were observed in 25 cases (23.4%). By univariate analysis, HER-2 positivity, triple negative (TN), and high Ki-67 index ( 14%) were risk factors of a lower RFS (hazard ratio (HR) 6.680, 95% confidence interval (CI) 2.350-18.985, P<0.0001 for HER-2 positive; HR 4.769, 95%CI 1.559-14.591, P=0.006 for TN; HR6.030, 95%CI2.659-13.674, P<0.0001 for high Ki-67index). Patients with grade 3 tumors had a lower RFS (HR 2.922, 95%CI 1.096-7.791, P=0.032) compared with those with grade 1 or grade 2 tumors. By multivariate analysis, HER-2 positivity (HR 10.204, 95%CI 3.391-30.704, P<0.0001), TN (HR 10.521, 95% CI 3.152-35.113, P<0.0001) and high Ki-67 index (HR 10.820, 95%CI 4.338-27.002, P<0.0001) remained risk factors of RFS. In this cohort, HER-2 positivity, triple negative and high Ki-67 index were independent risk factors of RFS in young patients with T1a,bN0 breast cancer. Subsequent pregnancy did not affect RFS. We aimed to investigate risk factors of local and distant recurrence in small-sized, node negative breast cancer in women <35 years in a Chinese cohort. Between January 1994 and January 2007, 107 patients with pathologically confirmed small-sized (1 cm), node negative breast cancer who did not receive neoadjuvant or adjuvant chemotherapy included included. The 5-year recurrence-free survival (RFS) was estimated according to the different prognostic variables. With a median time of 60 months (range, 8-60 months) follow- By univariate analysis, HER-2 positivity, triple negative (TN), and high Ki-67 index (14%) were risk factors of a lower RFS (hazard Ratio (HR) 6.680, 95% confidence interval (CI) 2.350-18.985, P <0.0001 for HER-2 positive; HR 4.769, 95% CI 1.559-14.591, P = 0.006 for TN; HR6.030, 95% CI2. 659-13.674, P <0.0001 for high Ki-67index. Patients with grade 3 tumors had a lower RFS (HR 2.922, 95% CI 1.096-7.791, P = 0.032) compa By multivariate analysis, HER-2 positivity (HR 10.204, 95% CI 3.391-30.704, P <0.0001), TN (HR 10.521, 95% CI 3.152-35.113, P <0.0001 ) and high Ki-67 index (HR 10.820, 95% CI 4.338-27.002, P <0.0001) remained risk factors of RFS. In this cohort, HER-2 positivity, triple negative and high Ki- 67 index were independent risk factors of RFS in young patients with T1a, bN0 breast cancer. Subsequent pregnancy did not affect RFS.