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ABSTRACTBackground: Breast cancer is one of the leading cause of morbidity and mortality in Ethiopia. Adjuvant hormonal therapy (AHT) is one of the treatment modality given for a patient with breast cancer with estrogen receptor positive after primary treatment for 5-10 years. Nonadherence to adjuvant hormone therapy in breast cancer survivors is common and associated with increased risk of recurrence of cancer, invade the other breast, and consequently increase morbidity and mortality. Objective: To assess level of adherence to adjuvant hormonal therapy and associated factors among women with breast cancer who attends oncology outpatient at Tikur Anbessa Specialized Hospital. Method: Institutional based cross-sectional study was conducted. Convenience sampling technique was used to select 216 participants. A semi-structured questionnaire was used after some modifications and Morisky Medication Adherence Scale (MMAS-8). Data were entered in EpiData version 4.4.2.1 and exported to SPSS version 24, and analyzed using ordinal logistic regression with OR and 95%CI. Result: Out of 216, 209 women with breast cancer participated in the study with response rate of 97%. The level of adherence was 41%, 33%, and 26% for low, medium and high adherence respectively. Age group <45 is likely to be high adherence compared to >65 with (OR= 2.6, CI (3.8-7.6) p-value 0.001); being from urban (OR= 1.5, CI (1.1-2.8, p-value 0.001); being ontamoxifen (OR= 1.6, CI (0.4-2.2), p-value 0.005); having side effect (OR= 1.5, CI (0.4-1.9), p value 0.004); comorbidity (OR= 1.6, CI (1.5-3.4, p-value 0.001) and Getting a thorough therapeutic communication (OR= 1.7, CI (1.2-3.2), p-value 0.001) were found to be significantly associated with adherence to AHT. Conclusions and recommendations: In summary, the high adherence level to AHT among women with breast cancer was 26% in Tikur Anbessa Specialized Hospital. Age, place of residence, types of AHT, side effect, comorbidity, therapeutic communication from health care providers were significantly associated with adherence. Healthcare provider should give health education concerning medication usage, management of side effects and should also give due attention to rural patient.Key words: Adherence, Adjuvant Hormone Therapy, Breast Cancer, Ethiopia