A retrospective analysis was performed on 260 elderly and 294 middle-aged patients with primary breast cancer. Cox regression analysis showed that the classic prognostic factors, such as negative lymph node status, small tumour size and positive oestrogen receptor (ER) status, were favourable indicators of survival and were similar in both the elderly and the middle-aged. When the elderly and middle-aged were considered together, older age (favourable) and the presence of association disease (detrimental) were additional significant prognostic factors. It is concluded that a physically fit elderly woman in the present study had a more favourable survival outlook than a younger counterpart with similar tumor size, lymph node and ER status and should be given the best available treatment based on tumour characteristics and not on age alone.