Background: NCCN guidelines recommend an individualized assessment of life expectancy, patient preferences, and health status for determining if annual surveillance mammogram should be performed in older adult breast cancer survivors with residual breast tissue. However, current practice patterns and risks/benefits of surveillance mammograms are understudied. Methods: Between October and December 2020, we mailed a survey to female breast cancer survivors who were at least 78 years old, enrolled in the Mayo Clinic Breast Disease Registry (MCBDR) after an initial diagnosis of breast cancer at age 74 or younger, and without known bilateral mastectomy or metastatic disease. MCBDR invites patients, who were seen at least once at Mayo Clinic Rochester within a year of an initial breast cancer diagnosis, to sign informed consent to collect bloodwork, tissue specimens, and complete yearly surveys. Survey items for this current project included questions on mammographic frequency and patient-perceived adverse effects of mammography. Sleep problems and pain severity were graded on a 0-10 scale. Results: We mailed this survey to 795 women who were thought to be eligible, and 647 (81%) responded. 98 of 647 were subsequently excluded because they reported that they had had bilateral mastectomies, resulting in a sample size of 549. The median age was 81 (range 77-96). 533 (97%) reported that they had at least one post-cancer mammogram, 82% of whom reported having mammograms annually, 6% biennially, 7% less than every other year, and 5% more often than annually. Amongst those who did have at least one post-cancer mammogram, emotional problems during the week before or after a mammogram were reported by 27%, with frequency reported as “rare” by 16%, “sometimes” by 8%, and “often” or “always” by <2%. Of these 533 women, 18% reported that during the week before or after a mammogram, they experienced sleep problems of 1-5 severity and 2% of 6-10 severity. 57% reported that mammography caused them pain of 1-5, and 16% of 6-10. Conclusions: Most elderly breast cancer survivors with residual breast tissue reported undergoing annual surveillance mammography after age 75. Pain was the most common patient-reported adverse effect. Because respondent bias may be influencing these results, it will be important to assess real world administrative claims data to assess patterns and risk/benefits of surveillance imaging in a more diverse population of elderly survivors.