California Cancer Reporting System Standards Volume I: Abstracting and Coding Procedures
(Site: breast excluding lymphomas)
BR could also be referred to as: Bloom-Richardson, modified Bloom-Richardson, BR, BR grading, Scarff- Bloom-Richardson, SBR grading, Elston-Ellis modification of Bloom-Richardson score, Nottingham modification of Bloom-Richardson score, Nottingham modification of Scarff-Bloom-Richardson, Nottingham-Tenovus grade, or Nottingham grade.
Code the tumor grade using the following priority order
BR scores 3-9.
BR grade (low, intermediate, high).
BR score may be expressed as a range, 3-9. The score is based on three morphologic features: degree of tubule formation/histologic grade, mitotic activity, nuclear pleomorphism/nuclear grade of tumor cells.
If a report uses words such as low, intermediate, or high rather than numbers, use the table below to code grade.
If only a grade of 1 through 4 is given with no information on the score and it is unclear if it is a Nottingham or BR Grade, do not use the table below. Continue with the next priority according to “Coding for Solid Tumors”, see Section V.3.6.2.
Code the highest score if multiple scores are reported (exclude scores from tests after neoadjuvant therapy began). Examples: different scores may be reported on multiple pathology reports for the same primary cancer; different scores may be reported for multiple tumors assigned to the same primary cancer.
Description |
Grade Code |
Score of 3 |
1 |
| Score of 4 | 1 |
| Score of 5 | 1 |
| Score of 6 | 2 |
| Score of 7 | 2 |
| Score of 8 | 3 |
| Score of 9 | 3 |
| Low Grade, Bloom-Richardson (BR) grade 1, score not given | 1 |
| Medium (Intermediate) Grade, BR grade 2, score not given | 2 |
| High Grade, BR grade 3, score not given | 3 |
Note: This grading system is coded in a site-specific factor for the applicable CS schema.