There have been no consistent breast cancer screening guidelines for women 65 years of age and older. Given that 15% of the population will soon be 65 years of age or older and given that breast cancer incidence rises dramatically with age, clear recommendations are needed. The most important issues are the following: is mammography effective in finding breast cancer in older women; is there direct evidence that mammography with or without clinical breast examination (CBE) decrease(s) mortality for breast cancer in older women; should there be an age cutoff for screening; and what are the appropriate intervals for screening mammography and CBE. This article summarizes the report of a specially convened forum to address these issues and provide directions for screening.