• Nottingham prognostic index
• breast cancer
• prognostication
• cut off points
• mitotic index

In an ideal world, once malignant disease is diagnosed, treatment is administered to effect a cure. Where a cure is not expected then an estimate of how soon the disease might recur or, more importantly, cause death, are issues now often raised. Estimates in most cases are derived from information provided in pathology reports, conveniently translated into a numerical index. For breast cancer, the Nottingham prognostic index (NPI), calculated from invasive cancer size, histological grade, and status of nodes for metastasis, is widely accepted to fulfill that need, and steroid receptor immunohistochemistry is the universal predictive test. In this current era of clinical governance and health equality, it is reasonable to ask questions of these indices, such as: what is the level of pathologist consistency for feature assessments, what is the best manner to discriminate between “degrees” of a feature, and should the cut off points be constant across the spectrum of all cancers?

“Where a cure is not expected then an estimate of how soon the disease might recur or, more importantly, cause death, are issues now often raised”