The third isoform (MT-3) of the metallothionein gene family is unique in that it has a limited tissue distribution, is not induced by metals, has a neuronal growth inhibitory activity, and sequesters zinc more effectively under zinc-depleted conditions. The goal of the present study was to determine whether MT-3 was absent in normal breast tissue, was overexpressed in breast cancers, and if MT-3 overexpression would be associated with disease outcome. A combination of immunohistochemistry and reverse-transcription polymerase chain reaction was used to demonstrate that the normal breast had no detectable expression of MT-3 mRNA or protein. Using immunohistochemistry, it was shown that MT-3 was overexpressed in 25 of 34 cases of breast cancer. In all cases of positive staining, MT-3 was diffusely localized to the cytoplasm. The tumors from these 34 cases were divided as to outcome based on known 5-year survival, with 20 patients being disease free at 5 years (good outcome) and the other 14 having recurring disease within 5 years (bad outcome). When analyzed for MT-3 staining, it was shown that there was a trend for increased MT-3 immunoreactivity in the group having bad outcomes. However, when the tumor subgrouping was further defined on the basis of carcinoma in situ (CIS), there was a marked significant difference in MT-3 staining between patients with good and bad outcomes. Limited to DCIS, MT-3 staining was significantly increased in patients with bad outcomes compared to those with good outcomes. Thus, these studies demonstrate that MT-3 is overexpressed in selected breast cancers and that overexpression is associated with tumors having a poor prognosis. (Am J Pathol 2001, 159:21-26) The metallothioneins (MTs) are a family of cysteine-rich, low molecular weight, intracellular proteins that bind transition metals.1 In both mice and humans, there are four classes of very similar MT proteins, designated MT-1 through -4, defined on the basis of small differences in sequence and charge characteristics.1,2 The MT-1 and MT-2 isoforms have been extensively studied, and are believed to serve an important role in the homeostasis of essential metals such as Zn 2ϩ or Cu 2ϩ during growth and development, as well as in the detoxification of heavy metals such as Cd 2ϩ and Hg 2ϩ , rendering the MTs important mediators and attenuators of heavy metal-induced toxicity, particularly hepato-and nephrotoxicity.