West Virginia has one of the oldest populations in the nation. Cancer is a common disease among the elderly. With the projected growth of the elderly population (defined as 65 years and older), cancer will become a major public health burden. This article provides a summary of cancer incidence in elderly West Virginians. Incidence data were obtained from the West Virginia Cancer Registry. Approximately 6,262 elderly persons are diagnosed with some form of reportable cancer in West Virginia each year. Among those aged 65 and older, the four leading primary cancer sites in the order of their relative frequency were lung and bronchus cancer (21.8%), prostate cancer (14.6%), colorectal cancer (12.7%), and female breast cancer (9.6%). In general, the burden of cancer was greater in elderly men than in elderly women. Knowledge of the epidemiology of cancer in the elderly can potentially help guide statewide cancer prevention and control efforts and be used for anticipating future health care needs in the state.