Life-expectancy and comorbid conditions must be considered in the process of treatment decision-making for elderly patients affected by breast cancer both in the adjuvant and metastatic settings. Moreover, the choice of adjuvant treatment in all age groups is based on two main points: endocrine responsiveness and risk of relapse without setting an upper age limit. The hormonal therapeutic armamentarium of the medical oncologist is now open to different options that may best be tailored to different clinical situations, particularly in elderly women.