Roger Blamey became one of the foremost breast surgeons of his generation and established at the City Hospital the Nottingham Breast Institute, a beacon for teaching and research. His main objective was to find a way to tailor the treatment of patients with breast cancer so that each individual received the most appropriate therapy for them, rather than the broad based standard of the day. To this end he set up in 1973 the Nottingham Tenovus breast cancer study, in collaboration with the Cardiff Tenovus Research Institute. A range of potential prognostic and predictive factors was studied in a large group of closely followed-up patients, leading in 1982 to the Nottingham prognostic index, based on pathological (not clinical) tumour size, histological grade (the Nottingham method evolved by his colleagues Elston and Ellis) and lymph node stage. It proved, with oestrogen receptor status, to be a reproducible tool for the stratification of patients into therapeutic groups. Combined with newer molecular markers, such as HER2, the NPI still remains relevant.