Objectives: Decision analysis study that incorporates patient preferences and probability estimates to investigate the impact of women’s preferences for referral or an alternative strategy of watchful waiting if faced with symptoms that could be due to breast cancer. Setting: Community-based study. Participants: Asymptomatic women aged 30-60 years. Interventions: Participants were presented with 11 health scenarios that represent the possible consequences of symptomatic breast problems. Participants were asked the risk of death that they were willing to take in order to avoid the health scenario using the standard gamble (SG) utility method. This process was repeated for all 11 health scenarios. Formal decision analysis for the preferred individual decision was then estimated for each participant. Primary outcome measure: The preferred diagnostic strategy, either watchful waiting or referral to a breast clinic. Sensitivity analysis was used to examine how each varied according to changes in the probabilities of the health scenarios. Results: A total of 35 participants completed the interviews, with median age 41 years (Interquartile range 35 to 47 years). The majority of the study sample were employed (n=32, 91.4%), with a third-level (university) education (n=32, 91.4%) and with knowledge of someone with breast cancer (n=30, 85.7%). When individual preferences were accounted for, 25 (71.4%) patients preferred watchful waiting to referral for triple assessment as their preferred initial diagnostic strategy. Sensitivity analysis shows that referral for triple assessment becomes the dominant strategy at the upper probability estimate (18%) of breast cancer in the community. Conclusions: Watchful waiting is an acceptable strategy for most women who present to their GP with breast symptoms. These findings suggest that current referral guidelines should take more explicit account of women’s preferences in relation in terms of the initial diagnostic strategy for symptomatic breast problems.