Using neoadjuvant treatment has increased over the past decade due to its ability to assess tumor sensitivity to systemic treatment in vivo, and to downstage breast cancer (BC) for increased breast conserving surgery (BCS). This study aims to compare the efficacy of neoadjuvant chemotherapy (NACT) and adjuvant chemotherapy (ACT) in women with BC stage II-III. Methods: This prospective randomized comparative study included women diagnosed with stage invasive BC and received either NACT or ACT. Results: The mean age of BC patients in group A was 54.4±12.5 years, while the mean age in group B was 48.7±11.1 years. In group A, 11of cases (61.1%) were grade 2 and 7 were grade 3 (38.9%) and in group B, 9 cases were grade 2 (50%) and 9 were grade 3(50%). The mean initial tumor size was 27.7±11.9 mm (range, 11-60) and after NACT was 20.1±7.5 mm (range, 10-36) (p-value=0.03). In group A the mean disease free survival (DFS) time was 29.8± 6.1months, with a median of 35 months. In group B, the mean was 31.2± 3.8 months, with a median of 34 months (p-value=0.4). The patients outcome among the patients under different types of surgery were stable in 50% and 77.3% of the Breast Conservative surgery (BCS) and Modified Radical Mastectomy (MRM) respectively (p-value =0.7). Conclusions: NACT followed by surgery is a safe and effective surrogate to conventional method (primary surgery followed by ACT) in treatment of BC stage II-III. NACT is as effective as ACT regarding overall survival (OS) and DFS.