The diagnosis and treatment of breast cancer disrupts patients’ lives, affecting quality of life. The psychological impact of breast cancer is well documented. Usually, but not always this adjustment impact resolves within the first year following diagnosis. Recent evidence is revealing the individual differences that affect how women respond over time to the diagnosis of breast cancer. This presentation will review recent work on different patterns of psychological distress over the first year following breast cancer surgery. Factors predicting distinct trajectories are described. Specifically, the roles of consultation factors, personality factors, and concurrent symptom distress in influencing distinct trajectory patterns are explored. This presentation will also show how initial trajectory patterns during the first year following primary breast cancer surgery predict long-term psychosocial outcomes over 6 years following surgery. Finally, the question of how to identify those who are risk for chronic distress will be discussed.