Breast cancer in elderly women is already a significant public health problem. Elderly women have a 6-fold higher breast cancer incidence rate and 8-fold higher mortality rate compared with non-elderly women. Because of demographic trends, the number of elderly women diagnosed with breast cancer is likely to increase substantially in the coming decades. Specifically, if incidence rates remain constant, we project a 72% increase in the number of elderly women in the US diagnosed with breast cancer by 2025, an increase from approximately 89,500 in 1998 to almost 154,000 in 2025. If this projection holds true, the sheer magnitude of the increase in patients has profound implications for the delivery of medical care. Considerable planning is needed to ensure that the infrastructure is in place to effectively treat these patients. The burgeoning number of elderly patients with breast cancer accentuates the need for more definitive evidence concerning preventing and treating breast cancer in the elderly. Treatment patterns for elderly patients with breast cancer have been shown to differ from those for non-elderly patients, but the evidence base for differentiating treatment plans by age is deficient. For example, information is needed to tease apart the relative importance of age per se compared with important age-related factors, such as comorbidity. Patient care will benefit from an interdisciplinary team approach that includes oncologists, geriatricians, surgeons, radiation oncologists, nurses and social workers. The continued increase in life expectancy necessitates well-crafted strategies for the primary and secondary prevention of breast cancer. Carefully addressing the priorities for breast cancer prevention and control in the elderly during the first portion of the century may reap substantial dividends by the end of the century.