As health care reform unfolds over the next several years, nurse-midwives will be increasingly addressing issues of health care in women of all ages across the life span. For older women, a prevalent condition that has received minimal attention in this age group has been breast cancer. Distinctions have been noted in the literature between older and younger women in terms of the biology, screening, and treatment of breast cancer. Despite theories that breast tumors in older individuals are more indolent and slower growing than those found in younger women, older women's mortality from breast cancer is higher. Although part of this is theorized to be due to other biologic processes, such as increased immune suppression with aging, it appears that most of the distinction between the courses of breast cancer in older and younger individuals has been related to decreased screening during advanced age. This manuscript describes the individual client, health care provider, and health care system barriers to each of the three major elements of breast cancer screening--breast self-examination, clinical breast examination, and mammography. Suggestions and caveats including ethical, legal, and political issues regarding breast cancer screening in older women are presented.