Background: Distant relapse of breast cancer complicates management of the disease and accounts for 90% of breast cancer-related deaths. Monocyte chemoattractant protein-1 (MCP-1) has critical roles in breast cancer progression and is widely accepted as a pro-metastatic chemokine. Methods: This study explored MCP-1 expression in the primary tumour of 251 breast cancer patients. A simplified ‘histoscore’ was used to determine if each tumour had high or low expression of MCP-1. Patient breast cancers were retrospectively staged based on available patient data. p < 0.05 was used to determine significance and changes in hazard ratios between models were considered. Results: Low MCP-1 expression in the primary tumour was associated with breast cancer-related death with distant relapse in ER− breast cancers (p < 0.01); however, this was likely a result of most low MCP-1-expressing ER− breast cancers being Stage III or Stage IV, with high MCP-1 expression in the primary tumour s ....