Given the widespread worries about future health in women with breast cancer, it is important to understand the predictors of such fear so that possible avenues for intervention can be formulated. In this longitudinal study of 44 women who had undergone breast cancer surgery, we look at demographic variables, cancer and treatment related symptoms, and denial coping measured post-surgery and their ability to predict future health fears at 6-weeks and 12-weeks post-surgery. At both follow-up periods, around 1 in 5 women had strong worries about their future health, and post-surgery future health fears significantly predicted future health fears. In a hierarchical multiple regression, controlling for post-surgery health fears, future health fears at both follow-up periods were predicted only by denial coping. Cross-lag analyses suggested that these relationships were causal. Findings suggest that denial coping is a powerful predictor of future health fears, with this relationship growing stronger over time. Future research should investigate which interventions can decrease denial, and whether this then decreases health fears in the aftermath of breast cancer surgery. Copyright © 2004 John Wiley & Sons, Ltd.