Objective To probe into the current situation and influencing factors of cancer-related communication problems from the perspective of spouses of young and middle-aged breast cancer patients, and to provide references for formulation of clinical intervention programs for spouses or couples. Methods Totally, 278 spouses of young and middle-aged breast cancer patients were surveyed by using the general information questionnaire, the Cancer-Related Communication Problems Scale for spouse, the Dyadic Coping Inventory, the Locke-Wallace Short Marital Adjustment and the Cancer Self-Efficacy Scale-Spouse. Results The spouses scored (15.66±2.27) points in cancer-related communication problems. Spouse self-efficacy, dyadic coping, years of marriage and cumulative time in caregiving were influencing factors of spouses′ cancer-related communication problems level （all P<0.05）, altogether explaining 40.1% of the total variation. Conclusion Spouses of young and middle-aged breast cancer couples had slightly-below-medium level of cancer-related communication problems. The spouses with low self-efficacy, low dyadic coping level, shorter years of marriage and shorter cumulative time in caregiving are more likely to have communication problems with patients. Medical staff should pay attention of spouses with shorter years of marriage and shorter cumulative time in caregiving, take self-efficacy and dyadic coping as the breakthrough point, and formulate relevant nursing measures for spouses or couples, so as to improve cancer-related communication between couples.