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Objective: Fear of cancer recurrence (FCR) is common in breast cancer survivors (BCS). This study examined the mediating role of illness representations in the relationships between FCR and physical symptoms, social constraint and self‐care self‐efficacy. Methods: In this cross‐sectional study, 385 women with breast cancer completed a series of questionnaires including the FCR Inventory, Social Constraints Scale‐15, Cancer Survivors Self‐Efficacy Scale, Illness Perception Questionnaire‐Revised and European Organization for Research and Treatment Quality of Life Questionnaire‐Breast Cancer. Structural equation modelling method was conduct by using a bootstrapping method. Results: Physical symptoms (β = 0.272, p < 0.01), social constraints (β = 0.130, p < 0.01), self‐efficacy (β = −0.233, p < 0.01) and illness representation (β = 0.261, p < 0.01) have direct effects on FCR. The indirect effects of physical symptoms (β = 0.10, p < 0.01), social constraints (β = 0.076, p < 0.01) and self‐efficacy (β = −0.025, p < 0.05) on FCR were partially mediated by illness representations. Conclusions: In this study, the effects of physical symptoms, social constraints and self‐efficacy on FCR were found to be mediated by illness representation. Reducing the impact of negative illness representations on FCR by reducing physical symptoms, increasing self‐efficacy, and promoting open disclosure of cancer‐related concerns may be effective in reducing FCR in BCS. [ABSTRACT FROM AUTHOR]