The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

Abstract: Background: Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods: Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results: Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion: There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes

Progesterone inserts may help to improve breeding readiness in beef heifers

The accurate determination of pubertal status in yearling beef heifers, possibly combined with the use of exogenous progesterone, allows females to produce the maximum number of calves over their lifetimes. This study aimed to determine the reliability of a reproductive tract scoring (RTS) system that combines manual palpation with ultrasound as a measure of pubertal status, and whether the treatment of heifers with progesterone-containing vaginal inserts - followed by breeding on the second estrus after removal of the insert - could result in increased conception rates compared to untreated heifers. Over 2 years, we found that RTS predicted pubertal status reasonably accurately. Progesterone-treated heifers were more likely to exhibit estrus than control heifers, but their overall breeding efficiency was not affected by progesterone treatment. Inadequate nutrition associated with increased pasture stocking density during both breeding seasons likely had a negative effect on the results of our study

Progesterone inserts may help to improve breeding readiness in beef heifers

The accurate determination of pubertal status in yearling beef heifers, possibly combined with the use of exogenous progesterone, allows females to produce the maximum number of calves over their lifetimes. This study aimed to determine the reliability of a reproductive tract scoring (RTS) system that combines manual palpation with ultrasound as a measure of pubertal status, and whether the treatment of heifers with progesterone-containing vaginal inserts — followed by breeding on the second estrus after removal of the insert — could result in increased conception rates compared to untreated heifers. Over 2 years, we found that RTS predicted pubertal status reasonably accurately. Progesterone-treated heifers were more likely to exhibit estrus than control heifers, but their overall breeding efficiency was not affected by progesterone treatment. Inadequate nutrition associated with increased pasture stocking density during both breeding seasons likely had a negative effect on the results of our study