Objective: We conducted a study comparing anxiety and depression by sexual orientation in long-term breast cancer survivors, testing the hypothesis that sexual minority women (e.g., lesbian and bisexual women) have greater levels of anxiety and depression. Method: From a state cancer registry, we recruited 257 heterosexual and 69 sexual minority women with a diagnosis of primary, nonmetastatic breast cancer. To increase the number of sexual minority participants, we used convenience recruitment methods and obtained an additional 112 sexual minority women who fit the same eligibility criteria as did the registry-derived sample. Using a telephone survey, we assessed clinical and demographic characteristics of the participants and the outcomes of anxiety and depression using the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983). Results: We did not confirm our study hypothesis but found that sexual orientation is associated with anxiety and depression through interactions with demographic and clinical factors. Younger age and lower socioeconomic status are associated with worse anxiety and depression. These factors explain less than 20% of the variance in anxiety and depression. Conclusions: This sample of long-term breast cancer survivors shows low levels of psychological morbidity, while some sexual minority survivors are more depressed. Future research should examine explanatory factors to account for the better-than-expected psychological rehabilitation of sexual minority survivors. (Contains 5 tables.)