Among older, long‐term breast cancer survivors, symptoms from previous treatment can generate uncertainty about whether they represent co‐morbid conditions, recurrence, or normal aging. This uncertainty can result in emotional distress and thoughts of recurrence. Communication with health care providers may help women reduce uncertainty and improve both emotional and cognitive well‐being. To assess the influence of symptoms, uncertainty, and communication with providers on well‐being, data from 203 Caucasian and African American survivors, 5–9 years post treatment, were tested using structural equation modeling. Symptoms, age, and uncertainty had the strongest influence on well‐being, regardless of race. There was an unexpected positive association between patient‐provider communication and thoughts of recurrence. Descriptive analysis revealed that 52% of women were unable to achieve their desired decision‐making role with health care providers. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29:18–39, 2006