Breast cancer is most common in the elderly and their needs are distinctly different from their younger counterparts. Although tumoricidal treatment may be given, a palliative approach to disease management will probably occur. Palliative and supportive care is an integral component of the management of the elderly breast cancer patient. Common problems include pain, cognitive impairment, depression, lymphoedema and ulcerating disease. End of life care and dignity therapy are also of great importance. Elderly patients with breast cancer are a unique cohort whose nuances with regard to palliative care issues rightly deserve special consideration. The main issues affecting the elderly breast cancer patient are discussed within this overview.