At present, the histological features of greatest weight in predicting the behavior of primary breast carcinomas are lymph node stage, histological grade and tumor size, and the presence of lymphovascular invasion. When combined, with each other and with clinical data, they can be used as a basis for selection of the most appropriate treatments, both surgical and systemic. Additional "predictive" markers provide invaluable information in the choice of the optimum treatment for patients with breast cancer who require adjuvant therapy. The assessment of ER status is essential in avoiding a time delay for patients who are unlikely to respond to hormone treatments, and patients with tumors that are HER2 negative will not benefit from trastuzumab. In summary, the histopathologist has a major role to play, not only in the diagnosis of breast cancer but in forming a part of the multidisciplinary management team, and providing vital prognostic and predictive data to enable the patient to receive the optimum treatment.

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