OBJECTIVES: Health-related quality of life is an important issue in the treatment of breast cancer (BC) and health-state utility values (HSUVs) are essential for cost-utility analysis. The aim of the study was to identify published values for common health states for breast cancer and to determine pooled estimates of HSUVs for each identifiable health state. METHODS: A systematic review of HSUVs for conditions relating to BC was undertaken. Thirteen databases were searched in March 2009. HSUVs were allocated to six categories: screening related states, preventative states, adverse events in breast cancer and its treatment, non-specific breast cancer, early breast cancer (EBC) states and metastatic breast cancer (MBC) states. Where appropriate meta analysis was used to provide utilities based on combining all available evidence. Mean utility estimates were pooled using ordinary least squares with utilities clustered within study group and weighted by both number of respondents and inverse of the variance of each utility. Regressions included controls for disease state, utility assessment method and other features of study design.  RESULTS:  Forty-nine articles were identified, providing 476 unique utility values.  From these, 117 values for MBC and 230 values for EBC were extracted and analysed by regression analysis.  Utilities were found to vary significantly by valuation method (e.g. in EBC standard gamble had higher valuations than TTO and EQ-5D), and source of values.  For MBC values significantly varied in expected direction by severity of condition, treatment and side-effects.  CONCLUSIONS: Despite the numerous studies it was not feasible to generate a definitive list of HSUVs that could be used in future economic evaluations, due to the complexity of the health states involved and the variety of methods used to obtain values. Future research into quality of life in BC should make greater use of validated generic preference-based measures for which public preferences exist.