Background: Approximately 60% of women with breast cancer (BC) are diagnosed with early stage disease with 5-year survival rates estimates of 84.4% to 98.6% depending on tumor type and extent of lymph node involvement. Despite high survival rates, many women experience recurrences after 5, 10 and even 15 years. Little is known about the influence of lifestyle and other 'host' factors and disease recurrence in 'long-term' survivors with low-risk disease. Methods: A retrospective case-only study of stage I-II BC patients, at The University of Texas M.D. Anderson Cancer Center from January 1, 1985 to December 31, 2000. The cases were disease free 5 years from diagnosis, and for whom baseline and follow-up information were available. We sought to compare epidemiologic and clinical factors among patients that had a late recurrence of their primary BC to those who did not. Results: A total of 2,468 patients were included in the original study from 1985 to 2000, of these 2,047 (83%) women were followed for >5 years. We obtained epidemiologic information on 1,057 (52%) women, of which 1,035 (98%) women were disease free and 22 (2%) had a recurrence after 5 years of being disease free. Multivariable analysis revealed that Hispanic women [Reference (Ref) Caucasian, (odds ratio (OR), 3.78, p =0.02] and heavy alcohol drinkers [Ref never drinkers, OR, 11.2, p=0.00] were significantly associated with recurrence in these patients with low risk disease, after adjusting for the year of diagnosis. No other clinical or histopathological characteristics at diagnosis or other epidemiologic factors (BMI, smoking, family history) were associated with recurrence in this sub cohort. Conclusions: Though limited by inherent bias of non-inclusion of women lost to follow-up and a small sample size, to our knowledge, this is the first evidence suggesting that alcohol consumption may increase the risk of late recurrence in an otherwise good prognosis group. Our results contrast published findings of no overall main effect of alcohol at baseline as a risk factor for BC recurrence and suggest a need to test the effect of alcohol consumption on late recurrence, where tumor biology is less likely to overwhelm modest but significant effects of lifestyle factors.