[Objective] To explore the feasibility of exemption from radiotherapy after breast-conserving surgery for hormone receptor-negative elderly breast cancer. [Methods] A total of 139 estrogen receptor (ER) and progesterone receptor (PR)-negative older adults with breast cancer who underwent breast-conserving surgery admitted to the Second Affiliated Hospital of Nanchang University from December 1, 2013 to December 1, 2018 were recruited as the subjects of the study, and were divided into a case group of 67 patients who did not undergo postoperative radiotherapy and a control group of 72 ones who underwent postoperative radiotherapy, according to whether they received postoperative radiotherapy or not. Clinicopathological data including age, tumor T stage, tumor N stage, tumor Nottingham grade, pathology type, human epidermal growth factor receptor 2 (HER2) expression status, and chemotherapy regimen were collected and compared between the two groups. The study analyzed the 5-year disease-free survival (DFS) and 5-year overall survival (OS) of two groups of patients. The log-rank test was used to compare the survival rate, and a multifactorial COX proportional hazards regression model was used to analyze the effect of exempted radiotherapy after breast-conserving surgery on DFS and OS of hormone receptor-negative elderly breast cancer mammary carcinoma. [Results] The two groups did not significantly differ in age, tumor T-stage, tumor N-stage, pathological type, tumor Nottingham grade, HER2 status, or chemotherapeutic regimen (all P>0.05). The 5-year DFS rate of 139 hormone receptor-negative elderly breast cancer cases was 74.1% and the 5-year OS rate was 83.5%. The difference in the 5-year DSF rate between the case group and the control group was statistically significant (65.7 vs. 81.9%, P=0.023), but the difference in the 5-year OS rate was not statistically significant (79.1% vs. 87.5%, P=0.186). The results of multifactorial COX proportional risk regression model analysis showed that exemption from radiotherapy after breast-conserving surgery was an independent risk factor for DFS (HR=2.298, 95% CI: 1.113-4.746, P=0.024), but not for OS (HR=1.831, 95% CI: 0.740-4.532, P=0.191). [Conclusion] Hormone receptor-negative elderly breast cancer according to exemption of radiotherapy after breast-conserving surgery has a higher local recurrence rate, but OS has no significant effect. Therefore, whether hormone receptor-negative elderly breast cancer can be exempted from radiotherapy after breast-conserving surgery still needs to be verified by further clinical trials.