Background: Breast cancer (BC) is one of the most common cancers and the leading cause of death in women. Analysis of online databases revealed that FAM49B is highly expressed in BC and is associated with reduced disease-free survival (DFS) and overall survival (OS). However, the role of FAM49B in BC has not been elucidated yet. Therefore, in this study, we aimed to systematically study the role of FAM49B in the proliferation, metastasis, and chemoresistance of BC, as well as the corresponding mechanisms, and to provide new predictors and targets for BC treatment.Methods: We used western blotting and immunohistochemistry to quantify FAM49B expression levels in human BC samples. A combination of shRNA, co-immunoprecipitation, MTT, migration/invasion, and apoptosis assays, in addition to microarray detection and data analysis and a nude mouse xenograft tumor model, was used for further mechanistic studies.Results: In BC, the results showed that the expression level of FAM49B was significantly higher than that in normal breast tissue, and highly expression of FAM49B was significantly positively correlated with tumor volume, histological grade, lymph node metastasis rate, and poor prognosis. Knockdown or overexpression of FAM49B inhibited or promoted, respectively, the proliferation and migration of BC cells in vitro and in vivo. Microarray analysis revealed that the Toll-like receptor signaling pathway was inhibited upon FAM49B knockdown. In addition, the gene interaction network and downstream protein validation of FAM49B revealed that FAM49B positively regulates BC cell proliferation and migration by promoting the Rab10/TLR4 pathway. Furthermore, endogenous FAM49B interacted with ELAVL1 and positively regulated Rab10 and TLR4 expression by stabilizing ELAVL1. Moreover, mechanistic studies indicated that the lack of FAM49B expression in BC cells conferred more sensitivity to anthracycline and increased cell apoptosis by downregulating the ELAVL1/Rab10/TLR4/NF-κB signaling pathway.Conclusion: FAM49B may be a novel prognostic marker and therapeutic target for BC.