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PURPOSE: The interval between breast cancer diagnosis and surgery is psychologically demanding, and meeting the Swedish standardised care pathway target has remained challenging. We examined whether diagnosis-to-surgery lead time is associated with patient-reported psychological outcomes. METHODS: We conducted a longitudinal cohort study using Swedish National Quality Register for Breast Cancer data (2020-2024). The cohort comprised 2,906 women with primary invasive breast cancer undergoing surgery, with patient-reported outcome measure (PROM) data at baseline (n = 2,906), 6 months (n = 2,638), and 12 months (n = 2,678). Lead time from biopsy to surgery was modelled continuously (per 1 SD ≈ 19 days). The primary outcome was worry about future health (EORTC QLQ-BR23 item 43); secondary outcomes were general worry, tension, depressed mood, and overall quality of life. Associations were estimated using mixed-effects cumulative link models adjusted for clinical and tumour factors, pandemic era, patient, and healthcare region. RESULTS: Median lead time was 32 days (IQR 23-42). Longer lead time was associated with greater worry about future health (adjusted OR 1.15 per SD, 95% CI 1.04-1.27), while associations with the secondary outcomes were smaller and not statistically significant. At baseline, high future-health worry was more common with lead times > 35 vs. ≤ 35 days (42.2% vs. 35.1%). CONCLUSION: Longer diagnosis-to-surgery lead time was associated with greater future-health worry, with smaller, non-significant associations for general distress and quality of life. The findings highlight the preoperative waiting period as a potential context for improved communication about expected timelines and reasons for delay.