There are many issues of concern to internists and geriatricians as they face the prospect of implementing breast cancer screening programs for elderly women. Population heterogeneity and variations in comorbidity require individualization in order to maximize benefit. Decision making is complicated by family interactions, especially for patients with altered cognition. The time it takes to perform exams and discuss possibilities in a busy office practice may be inhibitory. Internists will want to see more definitive data on efficacy, specifically in women > age 70, but patients in this age cohort may actually rely on physicians' recommendations to a greater extent than younger cohorts.