PURPOSE: Breast cancer is the most common cancer affecting elderly patients. However, they may not receive optimal oncological care. Reasons might be comorbidities, limited compliance with clinical guidelines, and insufficient evidence for guideline recommendations. In the present review, the evidence for the clinical benefit of chemotherapy (CHT) in the population of elderly women with breast cancer was examined. METHODS: A systematic review of relevant literature in English identifying studies published from January 2000 to April 2023 was conducted. The analysis included studies on the application of CHT, effects on survival, and toxicities. We searched PubMed databases for relevant publications. In total, 24 studies were included in the present review. RESULTS: The benefit of CHT in elderly patients was inconsistent. Results of this review indicate evidence for the benefit of CHT in healthy elderly patients with high-risk breast cancer (BC) and specific subtypes such as triple-negative or HER2-positive BC. Data from studies on pathological complete response rates (pCR) or surgical downstaging rates after neoadjuvant chemotherapy (NACT) in different age groups are controversial. CONCLUSION: Results from studies on the effects of CHT in elderly patients are insufficient to draw differentiated conclusions due to heterogeneity of the definition for "elderly" patients, the application of different drugs and dosages. Patients with high-risk BC may benefit from CHT.