Nottingham Score for Breast Cancer

The Nottingham Scoring System is used to give each breast cancer a Nottingham score. Your Nottingham score is also called a grade or a histologic score and rates how aggressive a tumor may be.

To figure out your score, you need a biopsy done. A pathologist looks at samples of your breast tissue and lymph nodes in a lab using a microscope. The pathologist writes up a summary of their findings, which is called a pathology report.

The characteristics that the pathologist looks at are:

• Tubule formation: How much the tumor looks like normal cell structure.
• Nuclear pleomorphism: How different the tumor cells look from normal cells.
• Mitotic activity: How fast cells are dividing or reproducing.

How is a Nottingham score created?

Your Nottingham score is the total of 3 numbers. Each characteristic listed above is given a score from 1 to 3. 1 is the closest to normal and 3 is the most abnormal. These 3 scores are added together, making the Nottingham Score. The lowest score possible is 3 (1+1+1) and the highest is 9 (3+3+3).

The total score is assigned to a grade:

• Grade I (one) if your total score is 3 to 5. This is also called well differentiated.
• Grade II (two) if your total score is 6 or 7. This is also called moderately differentiated.
• Grade III (three) if your total score is 8 or 9. This is also called poorly differentiated.

Grade I cancers tend to be less aggressive. They are often estrogen receptor-positive (ER+). Grade III cancers tend to be more aggressive and more likely to be triple-negative breast cancer. This means the cancer is negative for ER (estrogen receptor) and PR (progesterone receptor) hormones and HER2 receptors.

Ask your provider any questions you have about your Nottingham score.