Background To address the fear of cancer recurrence (FCR) research gap, we used prospective data to explore FCR predictors and FCR associations with health‐related quality of life among Asian‐American breast cancer survivors (BCS). Methods A total of 208 diverse Asian‐American BCS completed T1 survey, and 137 completed T2 survey after 1 year. Results Fear of cancer recurrence scores (range = 0‐4) were 2.01 at T1 and 1.99 at T2 reflecting low‐to‐moderate FCR. Scores of FCR were stable over the 1‐year period (t(126) = .144, P = .886). Multiple regression analyses showed that Chinese women reported lower FCR both at T1 (t(193) = −2.92, P = .004) and T2 (t(128) = −2.56, P = .012) compared to other Asian women. Also, more positive health care experience at T1 predicted lower FCR at T2 (β = −.18, P = .041). Controlling for other covariates, greater FCR at T1 predicted poorer outcomes 1 year later including lower physical (β = −.31, P < .001), emotional (β = −.37, P < .001) and functional (β = −.16, P = .044) well‐being and health‐related quality of life specific to breast cancer at T2 (β = −.31, P < .001). Conclusions We found substantial consistencies and some divergences between our findings with Asian‐American BCS and the existing literature. This prospective investigation reveals new information suggesting that Asian‐American subgroup variation exists and health care system factors may influence FCR. Thus, FCR studies should consider Asian subgroupings, cultural aspects, ie, level of acculturation and health care system factors including provider‐patient communication and treatment setting. Future research may benefit from contextualizing FCR within a broader distress framework to advance the science and practice of patient‐centered and whole‐person care.