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Breast cancer treatment decisions are complex for all women, but may be even more difficult for older women owing to age-related clinical and nonclinical factors. While many studies have evaluated surgical treatment outcomes for women with breast cancer, few have focused on these issues from the perspective of an older breast cancer patient. The research indicates that there is a need to improve the quality of decisions related to breast cancer treatment for women of all ages, so that decisions are both informed (i.e., based on an accurate understanding of the risks and benefits of treatments) and values-concordant (i.e., the treatment decision is consistent with the underlying values of the patient). Achieving high-quality surgical treatment decisions from the perspective of older patients may require innovative approaches for assisting patients with decision-making. Such approaches are likely to translate to more high-quality decisions and treatment plans that incorporate the individual characteristics of patients, including their age.