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To compare the health-related quality of life (HRQOL) of disease-free breast cancer survivors at the time of diagnosis and 1 year later with that of the general population (GP) and to examine the predictors of HRQOL change.Although studies that examine the changes HRQOL in breast cancer survivors with cohort design is increasing, few studies compared the HRQOL of breast cancer survivors from baseline (immediately after diagnosis) with that of the GP.We administered European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Quality of Life Questionnaire BR23 HRQOL immediately after diagnosis to evaluate a population-based cohort of 286 women with breast cancer. We compared HRQOL scores of subjects internally and with reference data from the GP externally.We found no significant change in HRQOL internally except for diarrhea. In the external comparison, however, breast cancer survivors reported poorer HRQOL scores than the GP at baseline and a year later; clinically meaningful detriments were found for emotional and social functioning and for the symptoms of fatigue and insomnia, financial difficulties, and most of the breast cancer-specific domains (P < 0.01 for all). Multiple linear regression analysis revealed that menopausal status and the sociodemographic characteristics of education level, employment status, and physical activity at baseline and increased symptom problems were significantly associated with functioning changes.Immediately after the diagnosis of breast cancer, patients reported a lower HRQOL than the GP, and they continued to do so a year later. Increased levels of fatigue, pain, and insomnia were the main symptoms responsible.