Background: ER+ breast cancer (BC) by virtue of tumor dormancy can present with delayed recurrences, frequently years after initial diagnosis. Methods: Over 2,500 charts of ER+/HER2 negative BC patients were reviewed. Patients with follow up < 5 years, recurrence within 5 years and all local recurrences < or > 5 years were excluded. 35 late distant recurrences with minimum follow up of 5 years were identified. Data was analyzed with 50 patients without recurrences during same period. Following factors were used for analysis: age at diagnosis, tumor diameter, smoking history, T- and clinical stage at diagnosis, lymph node involvement (LNI), tumor-grade, histology, progesterone receptor(PR) status, duration of adjuvant therapy and treatment modalities. Recurrence and time to recurrence were assessed. Wilcoxon rank sum, Kruskal-Wallis tests and Chi-square tests were used for univariate analyses. Multivariate analysis was conducted using logistic regression and proportional hazards models. Results: The median/mean age at diagnosis was 58/58.5 years and median/mean age at relapse was 63/65.5 years respectively. Tumor size, T-stage at diagnosis, and duration of adjuvant therapy were associated with late relapse (p≤0.025, p≤0.012, p≤0.037 respectively). T-stage at diagnosis was only independent predictor identified; with an estimated odds ratio of 2.62 (95% CI: 1.22, 5.64) and an estimated hazard ratio of 2.22 (95% CI: 1.32, 3.72). No other significant association was detected (age at diagnosis; p≥0.21, tumor-grade; p≥0.27, histology; p≥0.17, smoking history; p≥0.79, LNI; p≥0.08, PR status; p≥0.58). Of patients with recurrent disease, 40% showed identical receptor profile and 11.4% had receptors changed/different from their initial diagnosis. Conclusions: In univariate analysis, the tumor diameter, T-stage at diagnosis and duration of adjuvant therapy are associated with both recurrences and time to relapse. Patients who received adjuvant therapy ≥ 5 years had decreased rate of late recurrences. In multivariate analysis, T-stage at diagnosis is the only independent predictor.