With the gradual aging of the population, there is a significant trend of increasing the number of elderly women over 60 years old with breast cancer. Due to the low awareness of the elderly to seek medical consultation, they are often locally advanced at the time of consultation and are not suitable for immediate surgery. Neoadjuvant therapy currently occupies an important position in the comprehensive treatment of breast cancer and its clinical application is becoming more and more widespread. In the past, chemotherapy was usually used, but elderly breast cancer patients are mostly accompanied with other medical diseases and poorly tolerate chemotherapy. Neoadjuvant endocrine therapy is safe and effective on the one hand, and on the other hand, it is convenient, does not require hospitalization and reduces medical costs, especially for the elderly and patients with poor general condition. On the one hand, neoadjuvant endocrine therapy has mild adverse effects and positive efficacy, on the other hand, it can provide information on tumor hormone sensitivity, and if preoperative endocrine therapy is effective, it can continue to be used after surgery, effectively guiding postoperative adjuvant therapy, thus allowing the use of chemotherapy not to be chosen and reducing the risk of adjuvant chemotherapy. Also more importantly, for patients with locally advanced breast cancer, neoadjuvant endocrine therapy reduces local tumor size, decreases clinical stage, creates surgical opportunities, and reduces the extent of surgical resection, thus reducing the disability caused by surgery. For neoadjuvant endocrine therapy without choosing chemotherapy, we should be strict in case selection: (1) elderly postmenopausal breast cancer patients over 60 years old with other important medical diseases and intolerable to chemotherapy; (2) pathologically clearly diagnosed breast cancer with positive expression of ER and/or PR indicated by immunohistochemistry; (3) able to accept and adhere to endocrine therapy; (4) mild adverse effects during treatment and no significant tumor progression .