Aim To investigate symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes, explore the impact of sentinel symptoms on patients' quality of life and psychological distress, provide a basis for implementing accurate symptom management. Design A cross-sectional survey. Methods The study was conducted from September 2021 to December 2022. We recruited 281 patients who were re-examined in an outpatient department of a tertiary hospital in Hebei Province. The European Organization for the Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire - Core30 (QLQ-C30), the EORTC Quality-of-Life Questionnaire Breast Cancer - 23 (QLQ-BR23), the Hospital Anxiety and Depression Scale (HADS) were used to conduct the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. Correlation analysis was used to explore the relationship between sentinel symptoms and quality of life, correlation with psychological distress. This paper adhered to the STROBE guidelines. Results Breast cancer survivors have a wide range of self-reported symptoms in the form of four symptom clusters: a fatigue symptom cluster, a gastrointestinal symptom cluster, a sickness symptom cluster and a surgical trauma-related symptom cluster. Three sentinel symptoms were explored: pain, alopecia and limited function of the upper limbs. Except for sexual function, all of the sentinel symptoms were negatively correlated with patients' quality of life and positively correlated with psychological distress (p < .05). Conclusions Breast cancer survivors have a variety of symptoms in the form of four symptom clusters. Pain, alopecia and limited function of the upper limbs are the sentinel symptoms, which affect patients' quality of life and psychological distress.