Breast Cancer grades and stages and classification systems

 
The histological grading of breast cancer has evolved as a means of helping to determine the prognosis or probable aggressiveness of breast carcinomas.

In North America the process has become somewhat standardized, but there are still varying methods of classification in other parts of the world.

 

 

I have a newer version of this page with more up-to-date information on the stages of breast cancers. However, this page is still very useful and I would still recommend using it.

 

American Joint Committee on Cancer

 
The American Joint Committee on Cancer (AJCC)  put together the Staging system.   This staging system enables a strategy for grouping breast cancer patients with respect to prognosis, and to help guide treatment decisions.

The main criteria in the AJCC staging classification systems are:-

•  tumor size
• lymph node status
• distant metastasis

 

 

Scharf Bloom Richardson Staging System:

 
The Bloom-Richardson breast cancer staging system has now basically been subsumed as the AJCC TNM classification system.

The main elements of the original Bloom Richardson Staging method were the:-

• degree of tumor tubule formation (or the percentage of the breast cancer composed of tubular structures)
• the mitotic activity or rate of cell division
• the degree of ‘nuclear pleomorphism’ of the tumor cells including any changes in cell size, shape and uniformity
• the nuclear grade.

The Bloom-Richardson breast cancer grading system was put forward in about 1957 as a way of classifying the approximate ‘prognosis’ when various cell characteristics and tissue structures are present.

The Bloom-Richardson staging system was modified in 1968 by Scarff and Torloni and adopted by the World Health Organization. Specialists refer to this breast cancer grading system usually as the ‘Scharf-Bloom-Richardson‘ histological grading system.
 

 

The Elston-Ellis breast cancer grading system, or the ‘Nottingham Grading System’

 
The Elston-Ellis system, also called the “Nottingham grading system” or “Nottingham Prognostic Index”, was a modification of the original Bloom-Richardson system, and is still in use in many places in Europe.

Elston-Ellis grading modification places an emphasis on the percentage of tubule formation on the tumor, the mitotic count and rate, and the degree of nuclear pleomorphism, arriving at a ‘combined histological grade‘.

For example, the Bloom-Richardson system, (modified by Scharff and Torloni in 1968) no longer addressed considerations such as apoptotic cells and hyper chromatic nuclei, and the Elson-Ellis modification also defines mitotic count in terms of square millimeters.

Black’s Nuclear staging system for breast cancer

 
The Black method for breast cancer grading and staging was primarily concerned with nuclear grading, and excluded the consideration of tubules and tubules formation as a criterion.  It has no relevance now, but was an important step in the evolution of histological tumor grading methods in place today.

Ann Arbor Staging system

 
One will occasionally read about the The ‘Ann Arbor’ staging system when researching breast cancer, but for comparison only.

This method was was not developed for breast cancer, but rather for lymphomas. It has approximately the same functions and classifications that one finds in the staging of solid tumors such as breast cancer tumors.  However, there is more emphasis on

• tumor location
• whether or not the lymphoma is growing or expanding in that location
• if tumors are appearing in different lymph node groups.

It is not used for discussions of breast cancer in common practice, but if breast cancer has spread to the lymph nodes, a physician might be tempted to use the Ann Arbor classifications as a means of illustrating the extent of lymph node involvement.
 

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For further reading, I suggest you visit this page on histology grade changes risk for ADH and DCIS, this page with information on clinical characteristics of breast cancers by age group, and also visit this page on breast cancer staging and treatment.
 

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References

• Breast. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 347-76.
• Woodward WA, Strom EA, Tucker SL, et al.: Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival. J Clin Oncol 21 (17): 3244-8, 2003.
• Singletary SE, Allred C, Ashley P, et al.: Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20 (17): 3628-36, 2002
• Paul P. Carbone, Henry S. Kaplan, Karl Musshoff, et al. Classification Report of the Committee on Hodgkin’s Disease Staging Cancer Res 1971;31:1860-1861
• Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63: 181-7.
• Elston CW, Ellis IO. Pathological prognostic factors in breast cancer: I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology (1991);19: 403-10.
• Bloom H, Richardson W “Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years.”. Br J Cancer 11(1957) (3): 359–77.

 

More References …

 

• Genestie, C; Zafrani, B; Asselain, B; Fourquet, A; Rozan, S; Validire, P; Vincent-Salomon, A; Sastre-Garau, X “Comparison of the prognostic value of Scarff-Bloom-Richardson and Nottingham histological grades in a series of 825 cases of breast cancer: major importance of the mitotic count as a component of both grading systems.”. Anticancer research (1998)18 (1B): 571–6.
• Black MM, Speer FD. Nuclear structure in cancer tissues. Surg Gynecol Obstet.( 1957);105:97–102
• Black, M.M., Opler S.R. and Speer F.D. Survival in breast cancer in relation to structure of the primary tumor and regional lumph nodes. Surg. Gynecol. Obster.,(1955) 100, 543-551.
• Scarff, R.W. and Torloni H. Histological typing of breast tumors., International histological classification of tumours, no. 2. Vol. 2. World Health Organization, Geneva,(1968) pp. 13-20
• Elston, C.W. and Ellis I.O. Assessment of histological grade. In Elston, C.W. and Ellis, I.O. (eds), The breast. (1998)Vol. 13. Churchill Livingstone, Edinburgh ; New York, pp. 356-384.
• Le Doussal, V., Tubiana-Hulin M., Friedman S., Hacene K., Spyratos F. and Brunet M. Prognostic value of histologic grade nuclear components of Scarff-Bloom-Richardson (SBR). An improved score modification based on a multivariate analysis of 1262 invasive ductal breast carcinomas. Cancer (1989)64, 1914-21.
• Carriaga, M.T. and Henson D.E. The histologic grading of cancer. Cancer (1995)75, 406-21.
• Pinder, S.E., Murray S., Ellis I.O., Trihia H., Elston C.W., Gelber R.D., Goldhirsch A., Lindtner J., Cortes-Funes H., Simoncini E., Byrne M.J., Golouh R., Rudenstam C.M., Castiglione-Gertsch M. and Gusterson B.A. The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy. Cancer,(1998) 83, 1529-39.

 
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