Neoadjuvant systemic therapy in breast cancer – a multicentre, prospective national audit

Aims and objectives

NeST is a multicentre audit to evaluate current practice in the use of neoadjuvant systemic therapies (NST) to treat breast cancer. The audit aims to:

  1. To establish current stated practice regarding the use of NST
  2. To determine the current practice of NST, including:
    1. Indications for use
    2. Treatment modalities in common use
    3. Monitoring of response to treatment
    4. Pathological reporting of response to NST
  3. To explore surgical decision-making in the context of NST with respect to both the breast and axilla
  4. To explore the use of further adjuvant therapies (radiotherapy and systemic therapies) following NST
  5. To determine pathological response rates to NST in routine clinical practice
  6. To establish best practice with regard to the use of NST, with a view to generating national guidelines.


This is a trainee-led multicentre audit, co-ordinated by the members of the NeST steering group.

Trainees from across the U.K. in both breast surgery and medical/clinical oncology will be invited to participate in the study, through the Mammary Fold, the National Research Collaboratives and oncology trainee associations. A local trainee lead(s) will be identified at each centre. Trainee leads will be responsible for identifying a supervising consultant and obtaining the necessary local audit approvals at their centre. Where there are no trainees within a unit, consultant, associate specialists, specialty doctors or research nurses will be encouraged to participate and enter data on behalf of their units.

There will be two phases to the study:

  1. A national practice questionnaire for MDTs, to determine stated practice within each unit
  2. A prospective audit phase for six months, collecting data on all women offered neoadjuvant systemic therapy (either chemotherapy, hormonal therapy or targeted therapies) following MDT discussion.

Inclusion criteria for prospective audit:

  • Age > 16 years
  • Histologically confirmed diagnosis of breast cancer
  • MDT recommended treatment of neoadjuvant systemic therapy – including patients entering into trials of NST.

Exclusion criteria for prospective audit:

  • Patients entering “window of opportunity” clinical trials

Research Governance

This project is being conducted as a prospective clinical audit. Local collaborators will be required to register the project with their local audit department prior to commencing data collection.

No patient identifiable data will be collected for the purposes of the study.

Get involved

The NeST Launch Meeting will be held on Monday 30th October at The Studio, Birmingham. Click here to register for free.  The programme is here: NeST launch meeting programme.

Please complete the form below to register as a collaborator. Don’t forget to use a NON-NHS email address!

  • Collaborator registration
  • National data collection
  • Data analysis
  • Manuscript submission
  • Publication
Mr Stuart McIntosh
Clinical Senior Lecturer in Surgical Oncology
Queen’s University Belfast

Dr Charlotte Coles
Reader in Breast Radiation Oncology,
University of Cambridge

Dr Ellen Copson,
Associate Professor in Medical Oncology
University of Southampton

Mr Ramsay Cutress,
Associate Professor in Breast Surgery
University of Southampton

Mr Rajiv Dave
ST8, Breast Surgery,
North West Deanery

Mrs Margaret Grayson,
Northern Ireland Cancer Research Consumer Forum

Professor Chris Holcombe
Professor of Breast Surgery,
Royal Liverpool Hospital,
University of Liverpool

Dr Finian Bannon
Lecturer in Medical Statistics, Centre for Public Health,
Queen’s University Belfast

Dr Sheeba Irshad
NIHR Academic Clinical Lecturer in Medical Oncology,
King’s College, London

Mr Gareth Irwin,
ST 8, Breast Surgery
Northern Ireland Deanery

Dr Ciara O’Brien
Specialist Registrar in Medical Oncology,
The Christie Hospital, Manchester

Professor Carlo Palmieri
Professor of Translational Oncology
University of Liverpool

Miss Shelley Potter
NIHR Clinician Scientist
Consultant Senior Lecturer in Oncoplastic Breast Surgery, University of Bristol

Dr Abeer Shaaban,
Consultant Histopathologist,
University Hospitals Birmingham

Dr Nisha Sharma,
Consultant Radiologist,
Leeds Teaching Hospitals NHS Trust

Mrs Jagdeep Singh
ST7, Breast Surgery,
Worcester Royal Hospital

Mr Ian Whitehead
ST6 Breast Surgery
North-West Deanery

Register now!
Association of Breast Surgeons Research Grant