Many older women today with early-stage breast cancer have estimated survivals exceeding 5–10 years at the time of diagnosis and should be considered for systemic adjuvant chemotherapy. When available and if eligible, such patients should be offered clinical trials participation. Given the median age for onset of breast cancer, trials should also be developed to specifically investigate the disease in this age group. Oncologists caring for elders need to educate their colleagues as well as their patients concerning the pitfalls of age bias and the potential hazard of under-treatment and poorer outcomes.