PURPOSE: Psychological distress is common in the cancer continuum. Our objectives were to determine the prevalence of distress and to investigate the related problems and the characteristics of women with breast cancer who experienced psychological distress at the time of diagnosis. METHODS: We used cross-sectional data from a questionnaire study. Women with newly diagnosed breast cancer were consecutively invited to respond before breast surgery. Between October 2008 and October 2009, a total of 357 responded out of 426 (84%) invited. Among these, 343 patients completed the 'distress thermometer' to measure psychological distress and the accompanying 'problem list' to identify related problems. Logistic regression models with 95% confidence intervals were used to estimate the associations between psychological distress, age, social support and domains on the problem list. RESULTS: With a cut-off of 3 on the distress thermometer, 77% of women with breast cancer reported distress, whereas when the cut-off was 7, 43% were distressed. The mean distress score was 5.4 (SD, 3.1). The most frequently reported problems were worry (77%) and nervousness (71%). Distress was significantly associated with the total score and three domains on the problem list. Younger women (