Synchronous bilateral invasive breast cancer is a rare event. The etiology of bilateral breast cancer is uncertain, but most evidence supports independent tumors and not metastasis spread from one of the primary tumors. The prognosis of bilateral breast cancer was once thought to be poor, but recent data has suggested a similar survival for bilateral breast cancers as compared to unilateral disease.

With an aging population, the management of elderly patients with breast cancer is recognised as an area of increasing concern. This population, however, represents a heterogeneous group whom, on the basis of age alone should not be denied any appropriate interventions in the management of their breast cancer. This article reviews the current issues in treating these patients and the paucity of evidence in this setting.