Lactose is the main carbohydrate in mammals' milk, and it is responsible for the osmotic equilibrium between blood and alveolar lumen in the mammary gland. It is the major bovine milk solid, and its synthesis and concentration in milk are affected mainly by udder health and the cow's energy balance and metabolism. Because this milk compound is related to several biological and physiological factors, information on milk lactose in the literature varies from chemical properties to heritability and genetic associations with health traits that may be exploited for breeding purposes. Moreover, lactose contributes to the energy value of milk and is an important ingredient for the food and pharmaceutical industries. Despite this, lactose has seldom been included in milk payment systems, and it has never been used as an indicator trait in selection indices. The interest in lactose has increased in recent years, and a summary of existing information about lactose in the dairy sector would be beneficial for the scientific community and the dairy industry. The present review collects and summarizes knowledge about lactose by covering and linking several aspects of this trait in bovine milk. Finally, perspectives on the use of milk lactose in dairy cattle, especially for selection purposes, are outlined.