Background: Breast cancer is the fifth leading cause of death in Indonesia. The prevalence of breast cancer in Indonesia is quite high, with 6% or 13.2 million people suffering from breast cancer. This study aims to determine the relationship between the neutrophyl-to- lymphocyte ratio (NLR) and distant metastases in breast cancer patients. Methods: This cross-sectional study was conducted on 124 breast cancer patients at the H. Adam Malik General Hospital Medan from February to April 2019. Results: Chi-square test showed a relationship between the NLR value and the incidence of metastasis (p <0.001), with odds ratio (OR) = 5.9 which states that in breast cancer patients with high NLR (> 3) there is an increased risk of distant metastases by ± 5.9 times. Conclusion: There is a significant relationship between the neutrophyl-to-lymphocyte ratio (NLR) and distant metastases in breast cancer patients treated at H. Adam Malik General Hospital Medan.