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For accurate patient-provider communication in oncology it is important to know more about factors influencing risk perceptions and the relation with fear of cancer recurrence (FCR). This study aimed to: 1) determine the accuracy of breast cancer survivors' estimations of their risk for locoregional recurrences (LRRs); 2) to examine which variables influence risk estimations, risk appraisal, and the accuracy of risk estimations; and 3) to investigate the influence of the objective LRR risk, risk estimations, and risk appraisal on FCR. Findings: of this study will inform clinicians on risk communication so that breast cancer patients are able to make informed choices with regard to their risk. In a cross-sectional survey among 258 breast cancer survivors, we measured women's recurrence risk estimations (in odds) and risk appraisal (in high/low), FCR, demographics and illness perceptions, about one year after surgery. Tumour- and treatment-related variables, obtained from electronic health records, were used to determine the objective risk for LRRs. This study is part of the SHOUT-BC study (Netherlands Trial Registry nr. NL8374). Half of the women (54%) accurately estimated their LRR risk, 34% of women underestimated and 13% overestimated their risk. Women's risk estimations and risk appraisal were only moderately positively correlated (r =.58). Higher risk appraisal was significantly associated with radiotherapy (r =.18) and having weaker cure beliefs (r = -.19). Younger age was significantly associated with overestimation of risk (r = -.23). Recurrence risk estimation and risk appraisal were significantly associated with more FCR (r =.29, r = 39). In regression, only risk appraisal contributed significantly to FCR. Although women were fairly accurate in their recurrence risk estimations, it remains difficult to predict over- or underestimation. Since risk estimation and risk appraisal were only moderately intercorrelated, clinicians should address both in their communication. [ABSTRACT FROM AUTHOR]