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A conservative approach to treating breast cancer patients was adopted for those more than 70 years of age with T1-3 and small localized T4b N0-1 lesions. It consists of tumor excision or simple mastectomy with adjuvant tamoxifen. From the prospective breast cancer database, patients 70 years or older at the time of diagnosis were identified for the period January 1990 to December 1996. Demographic, clinical, pathological, and oncologic data were retrieved. A total of 236 patients were identified. Ninety-seven patients (41%) were treated according to the conservative protocol. Of these, 74 had a tumor excision and 23 had a simple mastectomy. Their mean age was 79 years. TNM staging was stage I in 18 patients, stage II in 66 patients, and stage III in 13 patients. There was no 30-day mortality. Eleven patients were not compliant with tamoxifen use. Two patients were lost to follow-up. The mean follow-up is 51 months (range 4 to 109 months). The cumulative incidence of local and regional recurrence at 8 years is 5% and 7%, respectively. Locoregional recurrences were controlled with excision, mastectomy, or axillary dissection. The cumulative disease-specific, overall, and disease-free survival at 5 years is 86%, 64% and 46%, respectively. Tumor excision or simple mastectomy with tamoxifen offers sufficient tumor control for elderly patients. Axillary dissection and breast or chest wall radiotherapy can safely be omitted, thereby greatly reducing health care resource utilization.