8 Executive Summary Why present another report about breast cancer? Few would dispute that breast cancer has a higher profile than other types of cancer. Since the establishment of National Breast Cancer Awareness Month in the mid 1980s, a tremendous effort has been invested in messaging aimed at screening for early stage breast cancer, while celebrating those who survive diagnosis and treatment. The dominance of the “breast cancer survivor” identity masks the reality that patients treated for early stage breast cancer can experience metastatic recurrence. The focus on survivorship obscures the fact that, in spite of decades of breast cancer awareness and research funding, 40,000 women and men still die of breast cancer every year in the United States (US) [1] with metastasis the cause of virtually all deaths from breast cancer. Metastatic breast cancer (MBC), also referred to as stage IV breast cancer, is an incurable, albeit treatable, progressive cancer that originates in the breast and then spreads to other parts of the body, such as bones, liver, lungs, or brain. While some progress with research and new treatments has been made in reducing mortality rates from breast cancer, median survival after an MBC diagnosis is 3 years—and this has not increased meaningfully in more than 20 years[2] . Despite these statistics, research funding for MBC accounts for only 7% of the total breast cancer research investment. Currently, data are not collected on how many people experience a recurrence of early stage breast cancer as MBC or the number of people living with the disease. We have only estimates of how many women diagnosed with early stage breast cancer will experience a recurrence. For unknown reasons, their breast cancer returns after a few months or as long as up to 20 years or more after initial diagnosis. It is also estimated that at least 150,000 people of all ages and all racial and ethnic groups are living with MBC in the US[3] . Public messaging about the “cure” and survivorship is so pervasive that people diagnosed at stage IV with MBC can be stigmatized by the perception that they’ve failed to take care of themselves or undergo annual screening. With breast cancer organizations’ main focus on detection and screening of early stage breast cancer, MBC patients and their caregivers face real challenges in finding MBC-specific support and information from these organizations. Further, many MBC patients persist in believing a cure is likely, and health care professionals do not always have the time and skill to discuss treatment options when the prognosis is poor. A lack of awareness about MBC and how it differs from early stage breast cancer; little research funding to combat this unique and deadly disease; a lack of accurate statistics on incidence, prevalence, and survival; and difficulty in finding information and support services essential for people living with MBC—these are the issues that have defined the work of the Metastatic Breast Cancer Alliance (MBC Alliance) over the past year. 40,000 women and men still die of breast cancer every year in the US. Metastatic breast cancer originates in the breast and then spreads to other parts of the body, such as bones, liver, lungs, or brain. While treatable, MBC remains incurable.