OBJECTIVES: The purpose of this study was to estimate the preferences of postmenopausal women for disease states associated with EBC. METHODS: Preferences for relevant health states and demographic information were obtained from women aged 55–70 years in the UK and the USA with a history of stage one or two operable EBC and experience with adjuvant hormonal therapy. The 14 health states included in the study, which were compiled from literature and input from oncologists, reflected the major disease states of breast cancer and the adverse events reported in the ATAC trial (Cancer 2003; 98:1802–10). A chained standard gamble (SG) technique was used to compare health states to perfect and worst health (WH) and then WH against perfect health and death. WH values were used to rescale values (0=death, 1=perfect health). Pooled and country-specific utilities were analysed and compared. RESULTS: A total of 67 subjects (UK=23, USA=44) successfully completed the SG interviews. There were few differences between country samples. For the pooled sample, mean age was 67.8 years, 49% were retired, 61% were living with someone, and 51% had arthritis. More US than UK women had received radiotherapy and/or chemotherapy. Raw WH values differed significantly between country samples (UK=0.844, USA=0.455; p<0.001). Adjusted mean SG scores were 0.432–0.974 for the pooled sample, 0.710–0.989 for the UK sample, and 0.288–0.965 for the US sample. Mean current health values for the pooled, UK and US samples were 0.907, 0.933 and 0.893, respectively. CONCLUSIONS: The order of adjusted and unadjusted SG scores within each country was consistent, with the metastatic breast cancer and disease-free survival with no adverse events health states being the least and most preferred, respectively. When comparing utilities across countries, care must be taken in cases of significantly different WH values.