All sugarcane cultivars currently grown throughout the world arise from breeding programmes which have used a reasonably similar approach sustained over many decades. This comprises a continuous pipeline of operations of regular (usually annual) crossing among selected parent clones to produce large populations of seedling clones, followed by selection of these clones in successive stages of field trials for usually 9–12 years for important traits. This chapter outlines the history and structure of sugarcane breeding programmes as context for considering efforts to advance rates of progress. It reviews studies conducted in the last 30 years to improve many specific aspects of operations in sugarcane breeding programmes. Finally, it describes emerging concerns about whether current rates of genetic gain in sugarcane are optimal, and suggests some avenues for faster gains.