When observing causal sets directly related to metastatic breast cancer, the MBIL found that, at 5 years, direct causal sets of metastases with alpha of 1 were lymph-node positivity and the interaction of triple-negative breast cancer (TNEG) with HER2 assessments (Figure 2); with a more stringent alpha of 120, a direct causal set at 5 years was the interaction of ER, n-TNM and surgical margins; and with the highly interacting alpha of 480, the causal sets were stage, TNEG and ER in interaction with n-TNM and surgical margins (Figure 2). This evidence concerns the gene ESR1 and triple-negative breast carcinoma.