Breast cancer remains the most prevalent malignancy among women and the second leading cause of cancer-related mortality worldwide, primarily attributable to delayed diagnosis and limited therapeutic efficacy. Recent nanotechnology advances exhibit transformative potential in breast cancer management. Metal-organic frameworks (MOFs) have emerged as promising nanoplatforms for biomedical applications due to their exceptional adsorption capacity, high surface area, tunable porosity, structural stability, and facile surface functionalization-properties enabling advanced drug delivery systems (DDSs). This review systematically summarizes MOFs for DDSs and their applications in breast cancer. Classification by metal-ligand composition precedes critical analysis of synthesis methodologies, including comparative advantages and limitations alongside key factors influencing biomedical performance. A dedicated sections highlights normal and stimuli-responsive MOFs activated by endogenous or exogenous triggers. Furthermore, the application of multifunctional MOFs has been comprehensively explored, including chemotherapy, photothermal therapy, photodynamic therapy, immunotherapy, and diagnostic-therapeutic integration in breast cancer. Finally, challenges and possible solutions for MOFs in drug delivery are discussed.