This study examined treatment and survival among women with locally advanced breast cancer (LABC) through comparative analyses of women ≥70 years and those70 years. The primary endpoint was surgery with curative intention following neoadjuvant therapy. Secondary endpoints were 3-year disease free survival (DFS), overall survival (OS), response rates, and adherence to treatment guidelines.Patients diagnosed and treated for LABC between 2010 and 2019 at Odense University Hospital, Denmark, were eligible. Surgical information was dichotomized into surgery and no surgery for patients ≥70 years and70 years, and treatment response was extracted from scan and pathology reports. Adherence to treatment guidelines was registered for the initiated neoadjuvant treatment, and 3-year OS and DFS were estimated using Kaplan-Meier and Log-rank-test.Of 210 women, 57/102 (55.9%) of those ≥70 years received surgery with curative intent compared with 103/108 (95.4%) of those70 years. The main reason for omitting surgery was the patient's request. Fewer women ≥70 years received neoadjuvant therapy according to guidelines compared with their younger counterparts (63.7%Among women with LABC, women ≥70 years were less likely to receive neoadjuvant therapy according to guidelines. Only half of the patients ≥70 years reached the goal of surgery with curative intent, with no difference in 3-year OS and DFS between age groups.