This study examines the relationship between health beliefs and fear of cancer recurrence among breast cancer (BC) patients and develops a predictive model for cancer recurrence fear. A total of 120 patients from the Breast Surgery Department of a top tertiary hospital, spanning December 2022 to December 2023, were included in the study. Data were collected using general information questionnaires, Champion’s Health Belief Model Scale (CHBMS) and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF). The analysis revealed that CHBMS and FoP-Q-SF scale scores of BC patients were 94.17 ± 15.59 points and 34.90 ± 7.15 points, respectively. The total CHBMS score, perceived benefits, health motivation, and self-efficacy were negatively correlated with the total FoP-Q-SF score and its dimension scores (P < 0.05), whereas perceived severity, perceived susceptibility, type of operation, radiotherapy and chemotherapy treatment, and perceived barriers showed a positive correlation (P < 0.05). Significant differences in FoP-Q-SF scores were observed among patients of different ages, marital statuses, education levels, average monthly household incomes, levels of family caregiving, tumor node metastasis (TNM) stages, and types of medical insurance (P < 0.05). Multivariate logistic regression analysis identified age, marital status, education level, average monthly household income, family caregiving, TNM stage, chemoradiotherapy treatment, and CHBMS scale scores as significant factors influencing cancer recurrence fear (P < 0.05). A predictive model regression equation was established, and the model’s area under the ROC curve was 0.759 (95% confidence interval = 0.702 – 0.834, P < 0.001). Patients aged 50 years and older exhibited higher fear levels. This fear is also affected by age, marital status, education level, average monthly household income, family caregiving, TNM stage, and chemoradiotherapy treatment. The predictive model based on these factors demonstrates good predictive efficacy for cancer recurrence fear, providing a basis for early identification of high-risk patients and targeted nursing interventions.