Breast Cancer Grades (Nottingham Grade)

The grade of the cancer — also called the Nottingham grade or histologic score — describes how different a cancer cell’s appearance and growth patterns are from normal, healthy breast cells.

Although they both use a similar number system, it’s important to know that cancer grade is different from cancer stage. Grade is usually written in Arabic numbers (1, 2, 3), while stage is often written in Roman numerals (0, I, II, III, IV).

Doctors use the grade of the cancer — along with the cancer’s size, its hormone receptor status, and other characteristics — to determine cancer stage. The cancer’s stage helps you and your doctor decide on treatments.

The Nottingham score is a total of three different scores, each of which looks at the cancer’s characteristics:

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  tubule formation: how much the structure of the tumor cells looks like normal cell structure

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  nuclear pleomorphism or nuclear grade: how different the nuclei of the cancer cells look from the nuclei of normal cells (the nucleus of a cell stores its DNA and controls many of its functions, including how quickly the cell divides)

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  mitotic activity: how many cells are dividing and growing

Each characteristic is given a score of between 1 and 3, with 1 being the closest to normal and 3 being the most abnormal. These three characteristic scores are added together to get the Nottingham score. The minimum score is 3 and the maximum score is 9. There are three cancer grades based on the total score.

In general, the lower the cancer grade, the better the prognosis or expected treatment outcome.

A higher cancer grade is linked to a higher risk of recurrence (the cancer coming back) of early-stage breast cancer. The grade of the cancer is just one factor you and your doctor consider when deciding if treatments after breast cancer surgery make sense for you.

Grade 1 breast cancers — also called low grade or well-differentiated — have a score of 3 to 5. Grade 1 cancer cells look just a little bit different from normal cells and grow in slow, well-organized patterns. Not that many Grade 1 cancer cells divide to make new cancer cells. Grade 1 cancers tend to be less aggressive.

Grade 2 breast cancers — also called moderate grade or moderately differentiated — have a score of 6 to 7. Grade 2 cancer cells look different from normal cells and grow and divide a little faster than normal, healthy cells.

Grade 3 breast cancers — also called high grade or poorly differentiated — have a score of 8 to 9. Grade 3 cancer cells look much different from normal cells. They grow quickly in disorganized, irregular patterns, with many cells dividing to make new cancer cells.