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


This was an ABS endorsed study and is now closed. 

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

  1. To establish current stated practice regarding the use of NST across the UK
  2. To determine the current practice of NST, including:

    a. Indications for use

    b. Treatment modalities in common use 

    c. Monitoring of response to treatment

    d. 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

To determine pathological response rates to NST in routine clinical practiceTo 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 UK 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 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 behalp 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 chemotheraphy, 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