Although age per se is not an important determinant of cancer risk, but rather a surrogate of prolonged carcinogen exposure, the increased life expectancy over the last few decades in most areas of the world has greatly increased cancer burden in the elderly. Trends in mortality for most common cancer sites in the elderly tended systematically to increase up to the early 1990s, but declined thereafter in North America and Western Europe in both sexes, and in Japanese females. Most trends remain unfavourable for elderly population of both sexes in eastern Europe, mainly reflecting patterns in smoking. Trends of incidence in elderly populations are more difficult to interpret, on account of changed diagnosis and certification for several cancer sites, including prostate cancer, brain tumours and multiple myeloma. Screening and early diagnosis for cancer in the elderly should be critically considered for prostate, but also for colorectal, breast and other selected neoplasms.