Abstract
Metastatic breast cancer is not a curable disease, but women with metastatic disease are living longer. Although the relative survival has improved in recent years still patients who present with metastatic disease have a less than 30% 5-year survival. Historically, removal of the primary breast tumor has been offered to these patients only for palliation. However, there have been recent reports that removal of the primary tumor may improve survival. These are mostly retrospective studies limited by selection bias. Prospective and randomized trials have not shown a clear survival advantage. Although the definitive role of removal of the primary tumor in metastatic breast cancer is not settled, it is critical to understand the complexities of this debate in order to make further gains in breast cancer survivorship.