Background The EORTC QLU-C10D and the PROMIS Preference score (PROPr) are new health state utility (HSU) scores for Quality-adjusted life years (QALY) in cost-effectiveness analyses. Both are expected to measure HSU more comprehensively than existing measures in cancer patients by including cancer-related health domains such as fatigue. The aim of this study was to compare both scores in a sample of breast cancer patients. Methods We collected QLU-C10D and PROPr from 291 patients 90 days after treatment in the outpatient clinic of the breast cancer center at Charité University Medicine Berlin between June 2018 and April 2021. We assessed both scores’ convergent and known-groups validity, agreement, and ceiling and floor effects. Results The mean QLU-C10D score (0.71, 95%CI: 0.69; 0.74) and the mean PROPr score (0.43, 95%CI: 0.41; 0.46) differed systematically (0.28, 95%CI: 0.27; 0.30) and showed fair agreement (ICC 0.46, 95%CI: 0.32; 0.57). The Pearson correlation coefficient was 0.83 (95%CI: 0.79; 0.86). Both scores showed similar discrimination across known-groups of age, treatment, cancer stage, marital status, and education. The QLU-C10D showed relevant ceiling effects. Conclusions QLU-C10D and PROPr measure HSU differently as a result of different utility models. The choice between QLU-C10D and PROPr should be informed by context, population, disease, and treatment.