Patterns of care for women with breast cancer vary substantially with patient age. Older patients with breast cancer frequently receive less than standard management, resulting in poorer outcome. At diagnosis, the health status of older women with breast cancer affects survival and treatment decisions. Age-related comorbidity may limit diagnostic tests, narrow treatment options, and significantly increase mortality not related to breast cancer. Yet, for healthy older women with early-stage breast cancer, stage-adjusted survival is similar to that of younger women. Calendar age is not sufficient to encompass the heterogeneity in health status of the elderly. Instead, management of older women with breast cancer should be based on anticipated survival, functional status, and the goals of the patient for treatment. In this review, we evaluate pertinent data and provide guidance for the management of older women with breast cancer.