Background: 5 year disease specific survival (DSS) improvement among breast cancer (BC) patients has been observed over the past two decades. It is not known if this improvement extends to elderly women. Methods: Retrospective cohort study of BC patients from a dedicated BC registry database, years 1990-2007 (N = 1889). Chi square tests for bivariate proportional differences and Kaplan Meier survival analysis were used. The disease specific survival (DSS) endpoint was death from breast cancer. Results: Invasive breast cancer in patients age 65 and older was 62% mammography detected between 1990 and 2007 with no difference in detection method or stage by age (61% stage I, 27% stage II, 12% stage III). As age increased, patients were more often treated with surgery and radiation only [65-69 = 60%, 70-74 = 72%, 75-79 = 79%, 80+ = 82%, (p < .001)], and less often with chemotherapy [65-69 = 32%, 70-74 = 19%, 75-79 = 12%, 80+ = 82% (p < .001)] or hormonal therapy [65-69 = 74%, 70-74 = 71%, 75-79 = 66%, 80+ = 63% (p < .001)]. Patients 70 and older (n = 1302) had higher overall death rates [65-69 = 31%, 70-74 = 48%, 75-79 = 57%, 80+ = 62%] but an equal likelihood of breast cancer death [65-69 = 8%, 70-74 = 10%, 75-79 = 11%, 80+ = 7%]. Five year DSS improved significantly from 1990 to 2007 for patients age 65-69 from 93% to 98% but no improvement over time was observed among 70 and older patients (survival distribution equality test: p = .004). 5 year DSS did not improve over time for stage I breast cancer patients at any age. For stage II/III BC patients 5 year DSS only improved significantly over time for 65-69 year old patients [65-69: 1990-94 = 86%, 1995-99 = 94%, 2000-07 = 98% (p = .031) ; 70+: 1990-94 = 85%, 1995-99 = 90%, 2000-07 = 86% (p = .178)]. Conclusions: Breast cancer specific survival did not improve for higher stage breast cancer patients age 70 and older from 1990-2007, a time period in which both early detection and treatment improved. To improve survival in elderly women, consultation with oncologists regarding hormonal therapy options for estrogen receptor positive patients, early diagnosis by screening and development of tolerable treatment options for later stage disease are important priorities.