In a comprehensive medical chart review of over 150 breast cancer patients at one of the only cancer hospitals in northern Tanzania, we found that 91% of patients with breast cancer did not undergo hormone receptor testing, 44% did not receive axillary evaluation, 35% of those with symptoms did not undergo abdominal evaluation for metastatic disease, and 31% of cases were not confirmed by histopathology. Here, NR4A1 is linked to metastatic neoplasm.