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Neoadjuvant chemotherapy (NACT) is increasingly being used to treat early breast cancer, and offers several advantages, including reducing the extent of breast and axillary surgery, and providing an in vivo assessment of tumour sensitivity to treatment1–4. Clinical trials have identified tumour subgroups with high rates of pCR. A pCR can be achieved in 45–90 per cent of human epidermal growth factor receptor 2-positive (HER2+) tumours and triple-negative breast cancer (TNBC), but the rate in oestrogen receptor-positive (ER+)/HER2-negative (HER2–) breast cancer remains below 10 per cent3,5. Historically, increasing pCR rates following NACT have not translated into more breast-conserving surgery (BCS), but more recent data suggest that NACT can result in surgical downstaging6.NACT use in the UK appears inconsistent, as highlighted by a recent prospective audit7. Although UK guidelines suggest considering NACT in patients with HER2+ cancers and TNBC, detailed guidance does not exist8. Furthermore, it is unclear whether pCR rates in routine clinical practice reflect those observed in trials, and whether tumour downstaging influences surgical decision-making beyond the trial setting. Moreover, there remains a lack of consensus on whether definitive surgery should aim to excise the original or post-treatment tumour footprint, as highlighted in a recent UK survey9, in which 24 per cent of centres stated that their routine practice was to excise the original tumour footprint rather than carry out response-adapted surgery.This prospective study aimed to determine surgical decision-making in the breast and axilla and pCR rates in routine clinical practice following NACT for early breast cancer.

Additional file 1. SPIRIT checklist.

Additional file 2. Patient information sheet.

The last 20 years have seen significant advances in cancer care in Northern Ireland, leading to measureable improvements in patient outcomes. Crucial to this transformation has been an ethos that recognizes the primacy role of research in effecting heath care change. The authors' model of a cross-sectoral partnership that unites patients, scientists, health care professionals, hospital trusts, bioindustry, and government agencies can be truly transformative, empowering tripartite clinical-academic-industry efforts that have already yielded significant benefit and will continue to inform strategy and its implementation going forward.