Background: Two major components of breast cancer survivorship care include surveillance with mammograms and clinic visits after completion of definitive treatment. Identifying disparities in adherence to survivorship care is critical for improving the care delivery and outcomes of patients. Methods: We evaluated adherence to survivorship care among 4,212 racially/ethnically diverse Texan residents who underwent surgery for stage I-III breast cancer at the MD Anderson Cancer Center between January, 1997 and December, 2006 and completed one year of survivorship care. We used generalized estimating equations (GEE) method to evaluate race/ethnicity differences in missed mammograms and clinic visits up to 4 years of survivorship care. Results: The mean age of the cohort was 53 years (range 22-91); 72% white, 11% black, 11% Hispanic and 5% other race/ethnicity. Over four years, 36% of patients missed an annual mammogram and 21% of patients did not have a minimum of 1 clinic visit per year. For the entire study cohort, the trend of missed annual mammograms per year of survivorship care follow-up was 6% (year 1), 17% (year 2), 19% (year 3) and 22% (year 4) (p-trend <0.0001). In multivariable GEE model adjusted for survivorship year, age, stage, chemotherapy, endocrine therapy, radiation therapy and county of residence, Hispanic (OR 1.48 95% CI 1.22-1.80) and black (OR 1.41, 95% CI 1.15-1.72) patients were more likely be nonadherent with annual mammograms compared to white patients. Hispanic (OR 1.58, 95% CI 1.25-2.00) and black (OR 1.45, 95% CI 1.14-1.84) patients were also more likely to be nonadherent with clinic visits compared to white patients. There was a significant interaction between ethnicity and non-receipt of adjuvant endocrine therapy on clinic visit nonadherence (p-interaction=0.04) and annual mammogram nonadherence (p-interaction=0.001) among Hispanic compared to white patients. Conclusions: Drop out of breast cancer survivorship care increases over time and black and Hispanic women are more likely to be nonadherent. Better characterization of the reasons for nonadherence is needed to design interventions to improve retention in breast cancer survivorship care, especially for patients not receiving adjuvant endocrine therapy.