Nottingham Score and Recurrence

The University of Pennsylvania School of Nursing
Last Modified: December 13, 2011


My breast cancer came back just few months after lumpectomy. My pathology report says nottingham grade 3 of 3. What does this mean?


Brian Czerniecki, MD, Breast , responds:

This means it is high grade. The significance of recurrence post lumpectomy and XRT depends on the type of radiation you received your age and other factors, such as if you had whole breast radiation. Usually if you had recurrence that soon means you should probably have mastectomy.

Kevin Fox, MD adds more about the Nottingham Score:

The Nottingham histologic score is simply a scoring system to assess the "grade" of breast cancers.

It is a total score based on 3 different sub-scores. The 3 sub-scores are assigned based on 3 components of how the breast cancer cells look under a microscope. (The details of these 3 components are not critical for you to understand). Each of the 3 components is assigned a sub-score of 1, 2, or 3, with 1 being best and 3 being worst. Once the 3 sub-scores are added, a Nottingham score is obtained: the minimum score possible is 3 (1+1+1) and the maximum possible is 9 (3+3+3).

A histologic grade of III is assigned to any patient with a Nottingham score of 8 or 9. Grade I refers to Nottingham scores of 3, 4, and 5, while Grade II refers to Nottingham scores of 6 and 7.

In the end, the Nottingham score and histologic grades are not very useful in the big picture, as they do not alter final overall treatment recommendations. High-score cancers tend to relapse more often than low-score cancers. Ultimately, however, we don't use the score in making clinical decisions.

This question and answer was part of the OncoLink Brown Bag Chat. Series, View the Life After Breast Cancer transcript.


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