A 91-year-old woman was diagnosed as having ER-positive breast cancer, and was treated with primary endocrine therapy because she refused to undergo surgery under general anesthesia. The patient was treated with letrozole as the initial endocrine therapy, but was judged to have progressive disease after 11 months. During letrozole treatment, the patient could not achieve an effect greater than stable disease. Thereafter, she received toremifene treatment (40 mg/day). After three months of this treatment, the patient achieved a partial response. The response was maintained for 12 months, and the patient then underwent lumpectomy under local anesthesia. In conclusion, toremifene could be an effective preoperative primary endocrine regimen for elderly breast cancer patients.