Objective To explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) quantitative parameters in the clinical diagnosis of elderly breast cancer and their relationship with tumor malignancy. Methods A total of 102 elderly patients with breast cancer admitted to four hospitals of Hebei Province from April 2015 to February 2020 were recruited and assigned into the breast cancer group, and another 95 patients with benign breast lesions during the same period served as the control group. The diagnostic efficiency of IVIM-DWI quantitative parameters and their correlation with tumor malignancy were analyzed. SPSS statistics 21.0 was used for data analysis. Measurement data was tested by student′s t test. Pearson correlation analysis was adopted to analyze the correlation of IVIM-DWI quantitative parameters with the expression of proliferation genes (Notch1, CXCL1), invasion genes (FOXF1, NUAK1) and autophagy genes (ATG4D, ATG2B) in the breast cancer tissues. Results The apparent diffusion coefficient (ADC) value, diffusion coefficient (D) value, perfusion related diffusion coefficient (D*) value and expression levels of ATG4D and ATG2B were significantly lower, while perfusion fraction (f) value and expression levels of Notch1, CXCL1, FOXF1 and NUAK1 were obviously higher in the breast cancer group than the control group (P<0.05). Pearson correlation analysis showed that ADC value, D value, D* value, f value were positively correlated with the expression levels of Notch1, CXCL1, FOXF1 and NUAK1 and negatively with those of ATG4D and ATG2B in the tissue specimens of the elderly breast cancer patients (P<0.05). The D value under the receiver operating characteristic (ROC) curve had the largest AUC of 0.952, a sensitivity of 96.05%, and a specificity of 85.38%. The D value was significantly lower in the breast cancer patients with invasive ductal carcinoma, histological grade G₃, clinical stage Ⅲ-Ⅳ, and lymph node metastasis than those with other types of pathology, histological grade G₁₊₂, clinical stage Ⅰ-Ⅱ, and no lymph node metastasis (P<0.05 ). Conclusion The IVIM-DWI quantitative parameters in the elderly patients with breast cancer differ from those with benign breast lesions, and their changes are directly associated with tumor malignancy. So, these parameters can be used for early clinical screening and evaluation of malignancy.