Although malignant tumors occur at all ages, cancer disproportionately strikes individuals in the age group 65 years and older. Data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program for the most recent five-year period, 1998-2002, reveal that 56% of all newly diagnosed cancer patients and 71% of cancer deaths are in this age group. Median ages of cancer patients at death for the major tumors common to both males and females, all races (lung, colorectal, lymphoma, leukemia, pancreas, stomach, urinary bladder) range from 71 to 77 years. The median age for prostate cancer is 79 years; for ovarian and female breast cancer, the median age is 71 for each tumor. These cancer statistics when cast against the demographic changes occurring in the U.S. population take on urgency and importance for cancer treatment and care in our nation's health care system. The U.S. Census Bureau demographic projections indicate that the number of persons 65 years and older in the United States will double from the current estimate of 35 million persons to a projected 70 million by 2030. Barring any cancer prevention breakthroughs, the expansion of the aged population will likely increase the absolute number of older individuals diagnosed and treated for cancer in coming decades. The United States is not unique as an aging developed industrial nation with a high proportion of the cancer burden in the elderly. Other developed industrial countries have a potentiality for increased cancer incidence and mortality as their populations grow older. This paper, using U.S. Bureau of Census demographic projections and current age standardized death rates per 100,000 population (from Worldwide Cancer Mortality Statistics, Cancer Mondial, WHO, and the International Association for Research on Cancer) compares cancer in the elderly in Italy and the United States. Italy is demographically ranked as the oldest nation in the world. Dimensions of the cancer burden challenge ahead are inferred in the context of two countries with aging populations to underscore the possible increase that demographic factors may have on the magnitude of the cancer problem for older persons in the next 25 years.