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Mental health is a critical component of overall wellness among breast cancer survivors of working age; however, research in this area remains limited in China. This study aims to evaluate the mental health status and identify associated factors among this particular population. A cross-sectional study was conducted from July 5 to November 5, 2023, at a cancer hospital in Beijing, with patients from across China. A total of 443 postoperative breast cancer survivors of working age were recruited. Data on socio-demographics including occupation before diagnosis and current work status, diagnosis and treatments were self-reported by participants. Mental health status was assessed using GAD-7, PHQ-9, and FCRI-SF for anxiety, depression and fear of cancer recurrence (FCR) symptoms, respectively. Descriptive and logistic regression analyses were used to explore associations between socio-demographic, clinical factors and mental health outcomes. Among 443 participants (mean age: 49.4 years; age 18β60; all women), 27.1%, 29.3% and 31.8% were assessed to have anxiety, depression and fear of cancer recurrence symptoms, respectively. Residents of Beijing (44.0%) were significantly less likely to report FCR symptoms than non-residents (adjusted ORβ=β0.57, 95% CI: 0.37β0.90, pβ=β0.02). Those with non-professional occupations before cancer diagnosis (47.6%) showed a trend toward a lower likelihood of depression (adjusted ORβ=β0.58, 95% CI: 0.34β0.99, pβ=β0.05). Residence and occupational disparities were associated with FCR and depressive symptoms. Digital health interventions may help address unmet psychological supportive care needs in non-central cities, while vocational rehabilitation support may benefit individuals with professional backgrounds.