The number of nucleolar organizer region proteins (NORs) identified by silver staining (Ag) was studied in 106 primary breast carcinomas. The AgNOR score (mean +/- SD) in tumours smaller than 2 cm was significantly lower than that in tumours larger than 2 cm (P < 0.05). However, there was no significant difference according to other clinicopathological characteristics. According to postoperative distant recurrence, the AgNOR count was significantly higher in the group with recurrence than in the group without recurrence (P < 0.05). Further, the survival rate was significantly lower in the high AgNOR score (> or = 3) group than in the low score (< 3) group (P < 0.01). The present study indicates that the AgNOR score in human breast cancer cells is useful for evaluating cell proliferative activity and may help predict postoperative distant recurrence and, ultimately, the postoperative prognosis of patients.