Approximately half of breast cancers occur in women 65 years or older. Some studies suggest that breast cancer may be a more indolent disease in this group of patients. Debate exists over the appropriate treatment of these women as they are significantly underrepresented in breast cancer research studies. As a result of comorbid conditions and patient refusal many are often treated less aggressively than their younger counterparts. This study investigated the recurrence rate in elderly breast cancer patients who had undergone lumpectomy as their primary treatment at our institution. A chart review was conducted on breast cancer patients treated from January 1, 1995 through September 26, 2000 with lumpectomy performed at Wake Forest University Baptist Medical Center. Study criteria included female gender and age greater than 65 years, first incidence of breast cancer, no evidence of distant disease at presentation, and availability follow-up assessed by clinical examination and mammogram records. Clinical and pathological features and treatments were evaluated. The Cox proportional-hazards model, Fisher's exact test, and analysis of variance were used for statistical analysis. One hundred thirteen patients met study criteria. The stage distribution was as follows: stage 0 (T(IS)), 16 per cent; stage I, 56 per cent; stage IIA, 24 per cent; and stage IIB, 4 per cent. With a median follow up of 30 months six (5%) patients developed locoregional recurrence, four (4%) developed contralateral cancer, and two patients (2%) developed distant disease. Mean time to recurrence was 21 months. No patient has died of breast cancer, but one patient died of a second malignancy. Radiation therapy and tamoxifen decreased recurrence as compared with no adjuvant treatment or with adjuvant radiation only (P < 0.05). We conclude that patients treated with tamoxifen and radiation therapy had a significantly smaller risk of recurrences than those treated with lumpectomy only or those receiving radiation alone. This supports similar treatment patterns recommended for younger patients. Women over 65 years of age should be carefully evaluated for adjuvant therapy.