An increased incidence of distant metastatic disease at presentation was found for: inflammatory cancer; symptoms of possible metastatic disease; T4 disease; tumour size at least 3 cm, or at least 2 cm with abnormal nodes on axillary ultrasonography; oestrogen receptor (ER)-negative, human epidermal growth factor receptor 2 (HER2)-positive disease; patients staged before commencing neoadjuvant chemotherapy; and those with previous ipsilateral breast cancer. This evidence concerns the gene ERBB2 and metastatic neoplasm.