Background: Despite growing numbers of older people with cancer, treatment decisions are often challenging, since evidence-based survival data according to staging and treatment progressively declines with increasing age, particularly among the oldest old. The aim of this study was to describe the association of increasing age and disease staging at presentation, on survival among women aged over 65 years, diagnosed with breast cancer. Methods: This was a nested case control study, comparing 3,270 patients with breast cancer to 13,163 non-cancer age-matched controls. Baseline characteristics and cancer data (followed up from 2000-2011) were gathered from the Israeli Central Bureau of Statistics 1995 census and the Israel Cancer Registry. Survival curves and Hazards Ratios adjusted for ethnicity and socioeconomic status were stratified for 5-year age groups. Results: The poor survival of metastatic cancer progressively deteriorated with increasing age; among patients age 80 years old and more, the median survival in the upper quartile was less than a year. On the other hand, women with early stage cancer had similar survival compared to the non-cancer controls, even showing a trend to improved survival among the oldest old. Similarly, the magnitude of the decreased survival among intermediate stage cancer was seen to attenuate beyond the age of 80. Compared to non-cancer controls, early breast cancer subjects had a non-significant decreased risk of death throughout follow-up, which actually achieved a borderline significance beyond age 85 with an adjusted HR = 0.60 (95%CI:0.358-1.009). The increased risk of death associated with Intermediate stage breast cancer gradually declined with rising age, falling from adjusted HR 3.26 (95%CI: 2.58-4.12) at age 65-69, to an adjusted HR of 1.20 (95%CI: 1.22-2.09) at age 80-84, slightly rising again beyond age 85. Metastatic disease was strongly associated with mortality at all ages. Conclusions: Elderly women with breast cancer presenting with localized disease have a comparable expectancy of life compared to non-cancer healthy controls irrespective of advancing age. In contrast, the poor prognosis of patients diagnosed with metastatic disease was seen to deteriorate with advancing age.