Elderly breast cancer patients are underdiagnosed and undertreated in our Breast Unit. Design and settingRetrospective study of Azienda Ospedaliera " Santa Maria" -Terni Italy. Breast Unit Years 2003-2007. PatientsA total of 87 breast cancer patients aged 70 years or older diagnosed between 2003 and 2007, treated in our Unit, was identified. The data for 3 prospectively chosen age subgroups (aged 70-74, 75-79, and 80 years) were subsequently analyzed. Main outcome measuresData were collected regarding the method of detection of cancer, tumor characteristics and staging, type of treatment, and patient comorbidities. Comparisons between age subgroups were made using a likelihood ratio 2 test. ResultsForty-six percent (41) of all patients presented with palpable breast cancer. Mammography was frequently used as an adjunct to the physical examination but was helpful in detecting occult disease in only 54% (47) of all patients and 38% (33) of patients older than 80 years. Although more than 70% (61) of patients were considered stage I or II, complete pathologic staging was only performed in 64% (56) of patients. Approximately 50% (43) of patients were treated with breast-conservation surgery; however, adjuvant radiation therapy was omitted in 55% (46%) of these patients. Additionally, only 29% (25) of patients with positive lymph nodes received chemotherapy, and 67% (58) patients who were estrogen receptor-positive received adjuvant hormonal therapy. ConclusionOlder breast cancer patients are more likely to be diagnosed and staged clinically. Mammography is underused as a screening modality. While breast conservation surgery was performed in about half of the patients, adjuvant radiation, chemotherapy, and hormonal therapies were frequently excluded.