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Triple-negative breast cancer in the UK and the NHS
Around 59,400 people a year are diagnosed with breast cancer in the UK and, on the charities' figure, around 15 percent of those cancers, more than 8,000 a year, are triple-negative; no UK registry publishes the share. This page follows the NHS route from a screening invitation or a GP referral through the one-stop breast clinic, the breast MDT, surgery and reconstruction to genomic testing, lists what the NHS funds today with the NICE and SMC decisions behind it including the one refusal, names the tests to ask for, the trials open in the UK and the UK-led trials that shaped care, and shows where England, Scotland, Wales and Northern Ireland differ.
Your pathway in the NHS
How the cancer usually comes to light, then the national standards that time each step. The standards are England's unless the four-nations section says otherwise.
Symptoms and a suspected cancer referral
53% (England, 2019, all breast cancers)More than half of breast cancers in England (53 percent in 2019) come through an urgent suspected cancer referral. NICE NG12 tells GPs to refer anyone aged 30 and over with an unexplained breast lump, and anyone aged 50 and over with discharge, retraction or other changes of concern in one nipple; to consider a referral for skin changes that suggest breast cancer or an unexplained axillary lump at 30 and over; and to consider a non-urgent referral under 30. Triple-negative cancers are diagnosed more often in women under 40 (Cancer Research UK), so a larger share than for other subtypes arrives this way rather than through screening.
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24); NICE NG12: suspected cancer, recommendations by site (breast cancer 1.4) (2015); Cancer Research UK: triple negative breast cancer (patient information, last reviewed 12 May 2026) (2026-05-12)
Screening
32% (England, 2019, all breast cancers)Around a third of breast cancers in England (32 percent in 2019) and in Northern Ireland (31 percent) are found by the screening programmes, which invite women from 50 (up to the 71st birthday in England, to 70 in Scotland, Wales and Northern Ireland) every three years. Triple-negative cancers are more often diagnosed under 40, below the screening age; the NHS does not publish route to diagnosis by receptor status, so the screen-detected share for triple-negative disease is a named gap.
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24); GOV.UK: NHS breast screening programme overview (England; last updated 18 May 2026) (2026-05-18); Public Health Scotland: Scottish breast screening programme statistics, annual update to 31 March 2023 (women aged 50-70) (2026-09-24); Public Health Wales: breast screening (Breast Test Wales) (2026-09-24); nidirect: breast screening overview (Northern Ireland) (2026-09-24); Cancer Research UK: triple negative breast cancer (patient information, last reviewed 12 May 2026) (2026-05-12)
Emergency presentation
4% (England, 2019)Few breast cancers are diagnosed as emergencies: 4 percent in England and 5 percent in Northern Ireland in 2019.
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24)
Family history and inherited risk
Triple-negative breast cancer is more common in women who carry an altered BRCA1 gene and in Black women (Breast Cancer Now, Cancer Research UK); Macmillan puts the share of triple-negative cancers caused by an inherited gene change at around 15 percent. NICE NG101 tells teams to offer BRCA1 and BRCA2 testing to women under 50 with triple-negative breast cancer even with no family history, and the National Genomic Test Directory's R208 criteria (as summarised by GeNotes) extend this to triple-negative breast cancer diagnosed under 60.
Sources: Breast Cancer Now: triple negative breast cancer (2026-09-24); Cancer Research UK: triple negative breast cancer (patient information, last reviewed 12 May 2026) (2026-05-12); Macmillan Cancer Support: triple negative breast cancer (reviewed 1 October 2023) (2023-10-01); NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14); NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05)
- 1Day 0: referralUrgent suspected cancer referral, a breast symptomatic referral or a screening recall
The clock starts when the GP refers on the suspected cancer pathway (NG12 1.4), when a breast symptomatic referral is made, or when screening recalls a woman for assessment. England retired the two-week wait to first appointment on 1 October 2023 and now measures the 28-day Faster Diagnosis Standard; Northern Ireland still reports a 14-day target for urgent breast referrals, met for 7.9 percent of patients in January to March 2026.
Sources: NICE NG12: suspected cancer, recommendations by site (breast cancer 1.4) (2015); NHS England: changes to cancer waiting times standards from 1 October 2023 (the page answered 202 with an empty body to OnCo on 24 September 2026; wording carried from the same day's gallbladder pass) (2023-10-01); Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (14-day breast, 31-day and 62-day targets) (2026)
- 2One-stop clinic: triple assessmentExamination, imaging and needle biopsy at one visit where possible
Breast units run one-stop clinics that combine examination, mammography or ultrasound and a core biopsy in one visit, aiming to give a diagnosis or a plan before the patient leaves (Guy's and St Thomas'; Belfast City Hospital; The Royal Marsden's clinics usually offer same-day results). The biopsy is what tells the pathologist the cancer is triple-negative.
Sources: Guy's and St Thomas': breast cancer (one-stop clinics, reconstruction at the time of surgery) (2026-09-24); Belfast Trust: breast cancers (one-stop breast clinic at Belfast City Hospital) (2026-09-24); The Royal Marsden: breast cancer (Sutton and Chelsea clinics, secondary breast cancer clinics, trials) (2026-09-24)
- 328 days: diagnosis or all-clearFaster Diagnosis Standard: told you have cancer, or that you do not, within 28 daysTarget 75%, rising to 80% by March 2026
NHS England's Faster Diagnosis Standard applies to urgent suspected cancer, breast symptomatic and screening referrals. The pathology report must state oestrogen receptor, progesterone receptor and HER2 status; the UK HER2 recommendations (2023) ask pathologists to report HER2-low (IHC 1+ or 2+ without amplification) as well as negative, because a HER2-low result opens a different medicine in Scotland.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (the page answered 202 with an empty body to OnCo on 24 September 2026; wording carried from the same day's gallbladder pass) (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (202 to OnCo on 24 September 2026) (2025-01); NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14); Rakha et al, UK recommendations for HER2 assessment in breast cancer: an update (covers HER2-low reporting), Journal of Clinical Pathology 2023 (2023)
- 4Breast MDTEvery case discussed at the breast multidisciplinary team meeting before treatment
The breast MDT (surgeon, oncologist, radiologist, pathologist, breast care nurse) decides the order of treatment. For triple-negative disease NICE NG101 (updated April 2025) says that where neoadjuvant chemotherapy is indicated the regimen should contain a platinum, a taxane and an anthracycline, and NICE TA851 adds pembrolizumab for early disease at high risk of recurrence or locally advanced disease. The MDT should also request germline BRCA testing at this point so the result is back before adjuvant decisions.
Sources: NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14); NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05)
- 531 days: decision to first treatmentTreatment starts within 31 days of the decision to treatTarget 96%
Applies to the first treatment and to each subsequent treatment: neoadjuvant chemotherapy with pembrolizumab, surgery, radiotherapy or adjuvant olaparib. Scotland and Northern Ireland measure the same 31 days (95 percent and 98 percent respectively).
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (the page answered 202 with an empty body to OnCo on 24 September 2026; wording carried from the same day's gallbladder pass) (2023-10-01); Scottish Government: NHSScotland performance against LDP standards, cancer waiting times (31 and 62 days, 95%) (2026-09-24); Department of Health (Northern Ireland): cancer waiting times (2026-09-24)
- 662 days: referral to first treatmentFirst treatment within 62 days of the urgent referralTarget 85% (planning target 75% by March 2026)
The headline standard for the whole route in England; Scotland sets 62 days at 95 percent and met it for 72.2 percent of patients in January to March 2026; Wales measures 62 days from the point of suspicion; Northern Ireland's 62-day figures for January to March 2026 were withheld for validation after the encompass patient record went live.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (the page answered 202 with an empty body to OnCo on 24 September 2026; wording carried from the same day's gallbladder pass) (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (202 to OnCo on 24 September 2026) (2025-01); NHS England: cancer waiting times statistics; Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (2026); Welsh Government: suspected cancer pathway quality report (2026-09-24); Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (14-day breast, 31-day and 62-day targets) (2026)
- 7Surgery and reconstructionBreast-conserving surgery or mastectomy, with reconstruction offered to everyone who has a mastectomy
For triple-negative disease surgery usually follows neoadjuvant treatment. NICE NG101 says to offer breast reconstruction after mastectomy, to offer both immediate and delayed options whether or not they are available locally, and to offer immediate reconstruction to women advised to have a mastectomy including those who may need radiotherapy, unless comorbidities rule it out. Guy's offers reconstruction at the same operation with implants or the patient's own tissue.
Sources: NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14); Guy's and St Thomas': breast cancer (one-stop clinics, reconstruction at the time of surgery) (2026-09-24); Breast Cancer Now: breast reconstruction (2026-09-24)
- 8Genomic testingGermline BRCA1, BRCA2 and PALB2 testing through the Genomic Laboratory Hub (R208); whole genome sequencing pilot for triple-negative disease (M234)
The National Genomic Test Directory's R208 panel (BRCA1, BRCA2, PALB2, and truncating variants in ATM and CHEK2) is available to women with triple-negative breast cancer diagnosed under 60, any breast cancer under 40 and other family-history criteria; a pathogenic BRCA1 or BRCA2 result opens adjuvant olaparib (TA886) and, in advanced disease, talazoparib (TA952). GeNotes also lists whole genome sequencing for triple-negative breast cancer of any stage as a pilot under code M234, needing a fresh tumour sample and a matched blood sample.
Sources: NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05); NHS England: National Genomic Test Directory (the page answered 202 with an empty body to OnCo on 24 September 2026); NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14)
- 9After surgeryPembrolizumab continued for up to nine cycles (TA851); olaparib for a year if germline BRCA (TA886); radiotherapy where indicated
The adjuvant options the NHS funds depend on what the pathologist finds at surgery and on the germline result. Capecitabine for residual disease after neoadjuvant chemotherapy has no NICE appraisal (see funding). Trials for residual disease are open in the UK (PHOENIX, TroFuse-012, ASCENT-05).
Sources: NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14)
Where you would be treated
20 centre entries across 4 nations, with what each offers for this cancer. The service model note below says what happens only at a specialist centre and what can be given closer to home under its MDT.
England
- Rapid diagnostic breast clinics, usually with same-day results
- Dedicated secondary breast cancer clinics and nurse specialists
- Lead centre for national breast trials; ASCENT-05 and TROPION-Breast02 site
- One-stop breast clinics
- Reconstruction at the time of breast surgery, with implants or the patient's own tissue
- PHOENIX and ASCENT-05 site
- Centre for Experimental Cancer Medicine (Peter Schmid, KEYNOTE-522 and KEYNOTE-355)
- DIAMOND (Barts-sponsored), TroFuse-012, ROSETTA Breast-01 and ASCENT-05 site
- Breast oncology
- PARTNER, TroFuse-012 and ROSETTA Breast-01 site
- Breast radiotherapy, systemic treatment and specialised (reconstructive) surgery for Greater Manchester
- Breast Disease Group co-chaired by Anne Armstrong
- PHOENIX, PARTNER and ASCENT-05 site
Cambridge Breast Unit, Addenbrooke's Hospital
Cambridge University Hospitals NHS Foundation Trust
Cambridge
- Screening and diagnostic breast clinics beside the Rosie Hospital
- Sponsor and lead centre of PARTNER; Precision Breast Cancer Institute
- Breast medical oncology (Ellen Copson)
- POSH cohort centre; PARTNER and ROSETTA Breast-01 site
- Breast oncology
- PARTNER, TROPION-Breast02 and ROSETTA Breast-01 site
- Breast oncology
- TroFuse-012 and ROSETTA Breast-01 site
- Breast oncology
- ASCENT-05 site
- Systemic treatment and radiotherapy for Merseyside and Cheshire
- ASCENT-05 and TROPION-Breast02 site
- Breast oncology
- PHOENIX site
- Breast oncology
- PARTNER and IZABRIGHT-Breast01 site
Bristol Haematology and Oncology Centre
University Hospitals Bristol and Weston NHS Foundation Trust
Bristol
- Breast oncology
- PARTNER, TroFuse-012 and ROSETTA Breast-01 site
Scotland
- NHS Lothian's regional breast unit (Western General) and regional screening centre (Ardmillan Terrace)
- TroFuse-012 and ROSETTA Breast-01 site
- Systemic treatment and radiotherapy for the West of Scotland; breast surgery at the health board hospitals
University Hospital Ayr and University Hospital Crosshouse
NHS Ayrshire and Arran
Ayr and Kilmarnock
- PARTNER sites in Scotland (ClinicalTrials.gov site list, 24 September 2026)
Service pageListed by Be Part of Research
Wales
- Non-surgical breast cancer treatment for South East Wales
- PHOENIX, PARTNER and TROPION-Breast02 site
Singleton Hospital, Swansea and the North Wales Cancer Treatment Centre, Glan Clwyd
Swansea Bay University Health Board; Betsi Cadwaladr University Health Board
Swansea and Rhyl
- PARTNER site (Singleton) and ROSETTA Breast-01 site (Glan Clwyd)
Northern Ireland
Belfast City Hospital and the Northern Ireland Cancer Centre
Belfast Health and Social Care Trust
Belfast
- One-stop breast clinic (Wing A, Belfast City Hospital Tower)
- Chemotherapy and radiotherapy for patients from all over Northern Ireland at the Cancer Centre
- IZABRIGHT-Breast01 lists a Belfast site
The service model
Breast cancer is not a specialised commissioned service the way liver or pancreatic surgery is: almost every acute trust and health board runs a breast unit with a one-stop diagnostic clinic and a weekly breast MDT, and NICE NG101 sets the standards they all work to, including that reconstruction is offered to everyone who has a mastectomy and both immediate and delayed options are offered whether or not they are available locally. What distinguishes the centres above is the trial portfolio for triple-negative disease and the research units attached to them (the Breast Cancer Now Toby Robins Research Centre at the ICR with The Royal Marsden and Guy's, the Precision Breast Cancer Institute at Cambridge, the Centre for Experimental Cancer Medicine at Barts). Trial site lists come from each trial's ClinicalTrials.gov record read on 24 September 2026 and are given as offers; a patient anywhere can ask their own MDT to refer them to a trial site. No national list of breast units could be read: NHS England's pages answered 202 to OnCo and the Association of Breast Surgery's unit directory was not tried.
Sources: NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14); Guy's and St Thomas': breast cancer (one-stop clinics, reconstruction at the time of surgery) (2026-09-24); The Royal Marsden: breast cancer (Sutton and Chelsea clinics, secondary breast cancer clinics, trials) (2026-09-24); Belfast Trust: breast cancers (one-stop breast clinic at Belfast City Hospital) (2026-09-24); Cambridge University Hospitals: breast cancer (the Cambridge Breast Unit) (2026-09-24); NHS Lothian: breast imaging (the regional breast unit at the Western General Hospital) (2026-09-24)
What the NHS funds today
By line of treatment: England's NICE decision (which binds Wales and is adopted in Northern Ireland) and Scotland's SMC decision, each with its reference and date. Generic medicines were never appraised and are funded through national chemotherapy protocols.
| Line | Treatment | England (NICE) | Scotland (SMC) | Wales and Northern Ireland |
|---|---|---|---|---|
| Early or locally advanced, before surgery (neoadjuvant) | Pembrolizumab with chemotherapy, then pembrolizumab alone after surgery (KEYNOTE-522) | NICE TA8512022-12-14 Recommended within its marketing authorisation for triple-negative early breast cancer at high risk of recurrence or locally advanced breast cancer, with a commercial arrangement (routine commissioning, not managed access) | Wales: Follows NICE TA851 (New Treatment Fund, within 60 days). NI: Follows NICE TA851. | |
| Early, neoadjuvant chemotherapy backbone | A platinum, a taxane and an anthracycline (NG101 recommendation 1.8, 2025) The TA851 reference on this row is the appraisal that adds pembrolizumab to the same backbone; the platinum recommendation itself is NG101 1.8 [2025]. | NICE TA8512025-04-14 Guideline recommendation, not an appraisal: where neoadjuvant chemotherapy is indicated for triple-negative invasive breast cancer, offer a regimen containing a platinum, a taxane and an anthracycline; NICE's table gives three-year survival of 85 versus 81 in 100 and pathological complete response of 48 versus 33 in 100 with a platinum. Generic medicines funded through national chemotherapy protocols | SMC Not appraised (generic medicines); used under regional protocols | Wales: As England. NI: As England. |
| After surgery, germline BRCA1 or BRCA2 (adjuvant) | Olaparib for one year, alone or with endocrine therapy (OlympiA) Needs the R208 germline result; GeNotes notes the treatment was first made available through the Cancer Drugs Fund. | NICE TA8862023-05-10 Recommended within its marketing authorisation for HER2-negative high-risk early breast cancer treated with neoadjuvant or adjuvant chemotherapy in adults with germline BRCA1 or BRCA2 mutations, with a commercial arrangement | Wales: Follows NICE TA886. NI: Follows NICE TA886. | |
| After surgery, residual disease after neoadjuvant chemotherapy | Capecitabine for six to eight cycles (CREATE-X) | NHS England No NICE appraisal for this use: a generic medicine whose availability depends on the regional chemotherapy protocol. OnCo could not read the national Cancer Drugs Fund list (202) or a national protocol, so whether a given trust offers it is a named gap | SMC Not appraised (generic); regional protocols | Wales: As England. NI: As England. |
| Metastatic, first line, PD-L1 CPS 10 or more | Pembrolizumab with paclitaxel or nab-paclitaxel (KEYNOTE-355) NICE's IC under 1 percent condition carves the population so that it does not overlap with atezolizumab (TA639). | NICE TA8012022-06-29 Recommended for untreated triple-negative locally recurrent unresectable or metastatic breast cancer only if the tumour expresses PD-L1 with a combined positive score of 10 or more and an immune cell staining of less than 1 percent, with a commercial arrangement | SMC SMC24602022-10-10 Accepted for restricted use within NHSScotland: in combination with paclitaxel or nab-paclitaxel (end of life and orphan equivalent process) | Wales: Follows NICE TA801. NI: Follows NICE TA801. |
| Metastatic, first line, PD-L1 immune cells 1 percent or more | Atezolizumab with nab-paclitaxel (IMpassion130) | NICE TA6392020-07-01 Recommended within its marketing authorisation for triple-negative unresectable locally advanced or metastatic breast cancer with PD-L1 expression of 1 percent or more and no previous chemotherapy for metastatic disease, with a commercial arrangement | Wales: Follows NICE TA639. NI: Follows NICE TA639. | |
| Metastatic, germline BRCA1 or BRCA2 | Talazoparib (EMBRACA); olaparib (OlympiAD) | NICE TA9522024-02-21 Talazoparib recommended for HER2-negative locally advanced or metastatic breast cancer with germline BRCA1 or BRCA2 mutations after an anthracycline or a taxane or both (and endocrine therapy if hormone receptor positive), with a commercial arrangement. NICE's position on olaparib for metastatic breast cancer was not read on this pass | SMC SMC26072024-03-11 Talazoparib accepted for use within NHSScotland (end of life process, SMC2607, 11 March 2024); olaparib for metastatic germline BRCA breast cancer accepted after an abbreviated submission (SMC2737, 10 February 2025) following a 2021 non-submission (SMC2436) | Wales: Follows NICE TA952. NI: Follows NICE TA952. |
| Metastatic, second line and later | Sacituzumab govitecan (ASCENT) First-line sacituzumab (ASCENT-03, ASCENT-04) had no NICE appraisal that OnCo could find on 24 September 2026. | NICE TA8192022-08-17 Recommended within its marketing authorisation for unresectable triple-negative locally advanced or metastatic breast cancer after two or more systemic therapies, at least one for advanced disease, with a commercial arrangement; NICE judged it a life-extending end of life treatment | SMC SMC24462022-03-07 Accepted for use within NHSScotland (end of life and orphan equivalent process) | Wales: Follows NICE TA819. NI: Follows NICE TA819. |
| Metastatic, HER2-low (hormone receptor negative) | Trastuzumab deruxtecan (DESTINY-Breast04) The clearest four-nation split on this page: a patient with HER2-low triple-negative disease can have trastuzumab deruxtecan in Scotland but not in England, Wales or Northern Ireland. | NICE TA9922024-07-29 Not recommended for HER2-low metastatic or unresectable breast cancer after chemotherapy in the metastatic setting or early recurrence after adjuvant chemotherapy: the cost-effectiveness estimates were above the acceptable range even with the severity modifier. Treatment started before publication may continue | SMC SMC26082023-12-11 Accepted for use within NHSScotland for unresectable or metastatic HER2-low breast cancer after chemotherapy in the metastatic setting or recurrence within six months of adjuvant chemotherapy (end of life and orphan equivalent process) | Wales: Follows NICE: not available. NI: Follows NICE: not available. |
| Metastatic, after two or more chemotherapy regimens | Eribulin Not subtype-specific; the SMC position was not read on this pass. | NICE TA4232016-12-21 Recommended for locally advanced or metastatic breast cancer that has progressed after at least two chemotherapy regimens (which may include an anthracycline or a taxane, and capecitabine), with the patient access scheme discount | Not checked | Wales: Follows NICE TA423. NI: Follows NICE TA423. |
Every recommended row above is routine commissioning in England: none of TA851, TA801, TA819, TA886, TA639 or TA952 uses Cancer Drugs Fund managed access, and the national CDF list itself could not be read (202). Two appraisals for triple-negative disease are awaiting development at NICE with no expected publication date: datopotamab deruxtecan for untreated locally recurrent inoperable or metastatic triple-negative breast cancer (ID6435, rescheduled at the company's request to align with regulatory timing) and datopotamab deruxtecan with durvalumab for residual invasive disease after neoadjuvant treatment and surgery (ID6643). No NICE appraisal for first-line sacituzumab govitecan (ASCENT-03, ASCENT-04) was found. In Scotland, the SMC accepted every triple-negative medicine submitted to it and the only refusals on the breast list are non-submissions for hormone receptor positive indications (trastuzumab deruxtecan SMC2888, sacituzumab govitecan SMC2916). Wales adopts NICE appraisals through the New Treatment Fund within 60 days and the AWMSG appraises only medicines NICE will not; Northern Ireland's Department of Health endorses NICE appraisals.
Sources: NHS England: national Cancer Drugs Fund list (202 with an empty body to OnCo on 24 September 2026); NICE ID6435: datopotamab deruxtecan for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (awaiting development, expected publication TBC) (2026-09-24); NICE ID6643: datopotamab deruxtecan with durvalumab for triple-negative breast cancer with residual invasive disease after neoadjuvant treatment and surgery (awaiting development) (2026-09-24); Scottish Medicines Consortium: medicines advice, triple negative (2026-09-24); All Wales Therapeutics and Toxicology Centre: AWMSG in relation to NICE (2026-09-24); Welsh Government: the New Treatment Fund (medicines recommended by NICE and the AWMSG made available within 60 days)
The NHS position of every approved product is on the NHS coverage page; the same decisions by country are on HTA decisions.
Tests you can ask for
National Genomic Test Directory entries with their codes, what a result opens, and how the request is made. Ask at diagnosis of advanced disease, not at progression.
| Target | Code | Test | What a positive result opens | How to get it |
|---|---|---|---|---|
| Germline BRCA1, BRCA2, PALB2 (and truncating ATM, CHEK2) | R208 | Inherited breast cancer and ovarian cancer panel, blood sample | Adjuvant olaparib (TA886, SMC2518); talazoparib (TA952, SMC2607) or olaparib (SMC2737) in advanced disease; risk-reducing surgery and relatives' testing | Eligible with triple-negative breast cancer diagnosed under 60 (Test Directory criteria as summarised by GeNotes), any breast cancer under 40, bilateral breast cancer both under 50, breast cancer under 45 with a first-degree relative under 45, or Ashkenazi Jewish ancestry at any age. NICE NG101 1.3.6 says to offer BRCA1 and BRCA2 testing to women under 50 with triple-negative disease even with no family history. Requested by the breast or oncology team (mainstreaming) and sent to the regional Genomic Laboratory Hub; the Test Directory page itself answered 202 to OnCo. Sources: NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05); NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14); NHS England: National Genomic Test Directory (the page answered 202 with an empty body to OnCo on 24 September 2026) |
| TP53 (Li-Fraumeni) | R216 | Germline TP53, blood sample | Surveillance for the patient and relatives; affects radiotherapy decisions | GeNotes lists women diagnosed with breast cancer at 30 or under, or with triple-positive breast cancer at 35 or under, as eligible after counselling; it can be taken at the same time as R208. Sources: NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05) |
| Whole genome sequencing (tumour and germline) | M234 | Whole genome sequencing for triple-negative breast cancer of any stage (pilot) | Research-grade profiling that can surface targetable variants and trial options; not linked to a NICE-approved medicine | GeNotes: needs a fresh tumour sample and a matched blood (EDTA) sample, a record of discussion form, and a conversation with the local Genomic Laboratory Hub about the pathway before samples are sent. Sources: NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05) |
| PD-L1 | pathology | Immunohistochemistry on the tumour biopsy, reported as a combined positive score (CPS) and immune cell (IC) score | Pembrolizumab with paclitaxel or nab-paclitaxel if CPS 10 or more and IC under 1 percent (TA801, SMC2460); atezolizumab with nab-paclitaxel if IC 1 percent or more (TA639, SMC2267) | Not a Test Directory entry: the pathology laboratory runs it on the diagnostic or metastatic biopsy when the MDT requests it. Ask for it at the diagnosis of metastatic disease, because the first-line choice depends on it. Neoadjuvant pembrolizumab (TA851) does not need a PD-L1 result. Sources: NICE TA801: pembrolizumab plus chemotherapy for untreated triple-negative locally recurrent unresectable or metastatic breast cancer (CPS 10 or more, IC under 1 percent) (2022-06-29); NICE TA639: atezolizumab with nab-paclitaxel for untreated PD-L1-positive locally advanced or metastatic triple-negative breast cancer (2020-07-01); NICE TA851: pembrolizumab for neoadjuvant and adjuvant treatment of triple-negative early or locally advanced breast cancer (2022-12-14) |
| Oestrogen receptor, progesterone receptor and HER2, including HER2-low | pathology | Immunohistochemistry with in situ hybridisation for HER2 2+ cases, on every invasive breast cancer | The triple-negative label itself; a HER2-low result (IHC 1+, or 2+ without amplification) opens trastuzumab deruxtecan in Scotland (SMC2608) but not in England, Wales or Northern Ireland (TA992 not recommended) | Standard on the diagnostic core biopsy. The 2023 UK recommendations for HER2 assessment ask laboratories to report HER2-low as a category; if the report says only HER2 negative, ask for the IHC score. Sources: Rakha et al, UK recommendations for HER2 assessment in breast cancer: an update (covers HER2-low reporting), Journal of Clinical Pathology 2023 (2023); NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14) |
Germline testing has been mainstreamed: the breast team, not a genetics clinic, can request R208 and should do so at diagnosis of triple-negative disease so the result is available when adjuvant olaparib is being considered. In Scotland the same tests are requested through the Scottish genomic laboratories, in Wales through the All Wales Medical Genomics Service and in Northern Ireland through the Regional Molecular Diagnostics Service (GeNotes). The National Genomic Test Directory's own spreadsheets, which would give the current version and any somatic breast panel codes, could not be read because the NHS England publication page answered 202 with an empty body.
Sources: NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05); GeNotes: genomic testing in the devolved nations (2026-09-24); NHS England: National Genomic Test Directory (the page answered 202 with an empty body to OnCo on 24 September 2026)
Match a report to targets and drugs on the biomarker matrix.
Trials open in the UK
Registered trials with UK sites, from the ISRCTN registry and the sponsors' pages, with the setting each is for. Eligibility is decided by the trial team.
ISRCTN47127434 / NCT03740893Recruiting (registry, 24 September 2026)
PHOENIX (ICR-CTSU)
Residual triple-negative disease after neoadjuvant chemotherapy: pre-surgical window and post-surgical adjuvant biomarker study of DNA damage response inhibition with or without anti-PD-L1
The Christie, ManchesterGuy's and St Thomas', LondonKing's College Hospital, LondonRoyal Bournemouth HospitalVelindre Cancer Centre, CardiffWeston Park, Sheffield
Phase 2, 119 participants, sponsored by The Institute of Cancer Research; funded by Cancer Research UK (CRUKE/16/026).
Registry or sponsor page →NCT03150576Listed as recruiting on ClinicalTrials.gov (primary completion June 2024)
Neoadjuvant olaparib with platinum-based chemotherapy in triple-negative and/or germline BRCA breast cancer
30 UK sites including Addenbrooke's (Cambridge), The Christie, UCLH, Royal Free, Churchill (Oxford), Southampton, Bristol, Nottingham City, Velindre, Singleton (Swansea), University Hospital Ayr and University Hospital Crosshouse
Phase 2/3, 780 registered participants, sponsored by Cambridge University Hospitals; results published in Nature 2024.
Registry or sponsor page →NCT05633654Recruiting (registry, 24 September 2026)
Adjuvant: sacituzumab govitecan with pembrolizumab versus treatment of physician's choice for triple-negative breast cancer with residual invasive disease after neoadjuvant therapy
Barts HealthGuy's HospitalThe Royal MarsdenThe ChristieClatterbridgeQueen Elizabeth Hospital BirminghamHullMount Vernon (East and North Hertfordshire)TauntonYork
Phase 3, 1,514 participants, sponsored by Gilead.
Registry or sponsor page →NCT06103864Recruiting (registry, 24 September 2026)
First-line metastatic triple-negative breast cancer not eligible for PD-1/PD-L1 therapy: datopotamab deruxtecan with or without durvalumab versus chemotherapy
Research sites in Cardiff, Chelsea and Sutton (The Royal Marsden), Leicester, Liverpool, London, Oxford, Surrey and Taunton (ClinicalTrials.gov gives cities only)
Phase 3, 625 participants, sponsored by AstraZeneca; the medicine NICE ID6435 will appraise.
Registry or sponsor page →NCT06393374Recruiting (registry, 24 September 2026)
TroFuse-012 (MK-2870-012)
Adjuvant: sacituzumab tirumotecan with pembrolizumab versus treatment of physician's choice for triple-negative breast cancer without a pathological complete response after neoadjuvant therapy
St Bartholomew's Hospital, LondonSt James's University Hospital, LeedsRoyal Cornwall Hospital, TruroUniversity College London HospitalUniversity Hospitals BristolWestern General Hospital, Edinburgh
Phase 3, 1,530 participants, sponsored by Merck Sharp and Dohme.
Registry or sponsor page →NCT07173751Recruiting (registry, 24 September 2026)
ROSETTA Breast-01
First-line metastatic triple-negative breast cancer: pumitamig (BNT327, a bispecific PD-L1 and VEGF-A antibody) with chemotherapy versus placebo with chemotherapy
Churchill (Oxford)Edinburgh Cancer CentreHullNew Cross (Wolverhampton)Glan Clwyd (Rhyl)Royal StokeRoyal Sussex (Brighton)Southampton GeneralSt Bartholomew'sSt James's (Leeds)Royal FreeTorbayUCLHBristolSarah Cannon Research Institute, London
Phase 3, 558 participants, sponsored by BioNTech; started October 2025.
Registry or sponsor page →NCT06954480Recruiting (registry, 24 September 2026)
DIAMOND
PD-L1-negative metastatic triple-negative breast cancer: datopotamab deruxtecan with durvalumab versus datopotamab deruxtecan alone
Barts Cancer Institute, Centre for Experimental Cancer MedicineBarts Health NHS Trust, London
Phase 2, 140 participants, sponsored by Queen Mary University of London; UK academic trial.
Registry or sponsor page →NCT06926868Recruiting (registry, 24 September 2026)
Previously untreated locally advanced or metastatic triple-negative breast cancer: izalontamab brengitecan versus treatment of physician's choice
Sites in Manchester, London (three), Nottingham, Belfast and Truro (ClinicalTrials.gov gives cities only)
Phase 2/3, 600 participants, sponsored by Bristol Myers Squibb.
Registry or sponsor page →The list is the set of interventional trials for triple-negative breast cancer with a UK site and a recruiting status on ClinicalTrials.gov on 24 September 2026, excluding all-comers phase 1 studies. Links go to the NIHR Be Part of Research record for each trial, which draws on the same registries and renders in the browser; the ISRCTN registry answered its holding page to automated requests, so PHOENIX is linked through Be Part of Research with its ISRCTN number stated. Site lists are as registered and may lag what is open; eligibility is decided by the trial team.
Sources: Be Part of Research: PHOENIX (NCT03740893, ISRCTN47127434) (2026-09-24); Be Part of Research: PARTNER (NCT03150576) (2026-09-24); Be Part of Research: ASCENT-05 / OptimICE-RD (NCT05633654) (2026-09-24); Be Part of Research: TROPION-Breast02 (NCT06103864) (2026-09-24); Be Part of Research: TroFuse-012 (NCT06393374) (2026-09-24); Be Part of Research: ROSETTA Breast-01 (NCT07173751) (2026-09-24); Be Part of Research: DIAMOND (NCT06954480) (2026-09-24); Be Part of Research: IZABRIGHT-Breast01 (NCT06926868) (2026-09-24)
The UK trial legacy
TNT: platinum for BRCA carriers, not for all triple-negative disease (2008-2018)
The UK Triple Negative Trial randomised women with metastatic or recurrent locally advanced triple-negative or BRCA1/2 breast cancer to carboplatin or docetaxel and crossed them over at progression. Reported in Nature Medicine in 2018 by Andrew Tutt and colleagues, it found no advantage for carboplatin in the unselected population but a clear one in germline BRCA1/2 carriers, and it showed that BRCAness signatures did not pick out platinum responders. It was run by the Cancer Research UK funded ICR Clinical Trials and Statistics Unit and is why UK practice reserves single-agent platinum for BRCA carriers while the later neoadjuvant evidence (now NICE NG101 1.8) brought platinum into early-disease regimens for everyone.
Sources: Tutt et al, Carboplatin in BRCA1/2-mutated and triple-negative breast cancer BRCAness subgroups: the TNT Trial, Nature Medicine 2018 (2018); NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025) (2025-04-14)
POSH and OlympiA: what a BRCA result means after a triple-negative diagnosis (2000-2021)
POSH, a Southampton-led prospective cohort of 2,733 women diagnosed at 40 or under in 127 UK hospitals (Lancet Oncology 2018, Ellen Copson first author), found that germline BRCA carriers had the same overall survival as non-carriers and that carriers with triple-negative disease did better in the first two years, which argued against rushing risk-reducing surgery in the year after diagnosis. OlympiA (NEJM 2021), the international adjuvant olaparib trial with Andrew Tutt of the ICR and The Royal Marsden as first author and Breast Cancer Now among its funders, then showed a year of olaparib improves invasive disease-free and overall survival in high-risk germline BRCA early breast cancer; it is the evidence behind NICE TA886 and SMC2518.
Sources: Copson et al, Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study, Lancet Oncology 2018 (2018); Tutt et al, Adjuvant olaparib for patients with BRCA1- or BRCA2-mutated breast cancer (OlympiA), NEJM 2021 (2021)
PARTNER: olaparib before surgery, and the 48-hour gap (2016-2024)
PARTNER, sponsored by Cambridge University Hospitals and led by Jean Abraham, added olaparib to neoadjuvant carboplatin and paclitaxel in triple-negative and germline BRCA breast cancer and tested when to give it. The Nature 2024 paper and the University of Cambridge release report that in the germline BRCA group every one of the 39 patients who had chemotherapy followed by olaparib after a 48-hour gap was alive three years after surgery with one relapse, against 88 percent survival and nine relapses among the 45 controls; the release notes the schedule used 12 weeks of olaparib before surgery where the NHS currently gives 12 months after it. The trial recruited from 23 NHS sites (the registry lists 30) and is still listed as recruiting.
Sources: Abraham et al, The PARTNER trial of neoadjuvant olaparib with chemotherapy in triple-negative breast cancer, Nature 2024 (2024); University of Cambridge: new approach to treating aggressive breast cancers shows significant improvement in survival (PARTNER) (2024)
UK data
Each figure with its nation, period and the page it was read from. Survival figures are population averages and sit behind the usual disclosure.
New breast cancer cases a year
59,413
UK · 2019, 2021-2022 average
Around 59,000 in women and 420 in men; the most common cancer in the UK.
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24)
Share of breast cancers that are triple-negative
around 15%
UK · as stated 2026
Breast Cancer Now, Cancer Research UK (around 15 out of 100) and Macmillan (15 to 20 percent) all give this figure; Breast Cancer Now puts it at more than 8,000 women a year. No UK cancer registry publishes the share by receptor status.
Sources: Breast Cancer Now: triple negative breast cancer explained (blog, 18 September 2026) (2026-09-18)
Breast cancer deaths a year
around 11,200
UK · 2022-2024 average
Fourth most common cause of cancer death; rates down 46 percent since the early 1970s.
Sources: Cancer Research UK: breast cancer mortality (2026-09-24)
Ten-year survival, all breast cancer
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 76.6% ten-year survival, all breast cancer (UK, 2018 (predicted)).
- Triple-negative survival is lower than the all-type average; England's registry study of 2012-2013 diagnoses gave triple-negative cancers an adjusted hazard ratio for death of 2.00 (Møller et al 2016).
UK · 2018 (predicted)
Sources: Cancer Research UK: breast cancer survival (2026-09-24)
Diagnosed at an early stage (I or II)
85% (around 35,000)
England · 2022
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24)
Routes to diagnosis
53% urgent referral, 32% screening, 4% emergency
England · 2019
Northern Ireland 2019: 47 percent red flag referral, 31 percent screening, 5 percent emergency.
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24)
Treatment in the primary course
81% surgery, 62% radiotherapy, 36% systemic therapy
England · 2022
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24)
Triple-negative cancers: excess risk of death
adjusted HR 2.00 (1.84-2.17)
England · diagnosed 2012-2013, followed to end 2014
National registration data on 86,852 women; progesterone receptor status was complete for only 41 percent. Black women had an age-adjusted HR of 1.77.
Sources: Møller et al, Short-term breast cancer survival in relation to ethnicity, stage, grade and receptor status: national cohort study in England (86,852 women, 2012-2013), British Journal of Cancer 2016 (2016-10-25)
Less favourable tumour characteristics by ethnicity
greater odds of ER-negative, high grade and high stage disease in Black African and Black Caribbean women
England · diagnosed 2013-2018
116,577 women in NCRAS data; the differences were largest in Black women and in the older (53-70) group.
Sources: Gathani et al, Ethnicity and the tumour characteristics of invasive breast cancer in over 116,500 women in England (NCRAS data, 2013-2018), British Journal of Cancer 2021 (2021-05-26)
Female breast cancer registrations
5,208 (2024); 5,516 (2023)
Scotland · 2023-2024
Read from the Scotland-level CSV (CancerSite Breast, Sex Females); Public Health Scotland reports female breast cancer rates up 8 percent over the decade.
Sources: Public Health Scotland open data: annual cancer incidence, Scotland-level CSV (opendata_inc0024_scotland.csv, modified 18 August 2026) (2026-08-18)
Diagnosed at an early stage (I or II)
84% (around 4,300)
Scotland · 2023
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24)
62-day standard met
72.2%
Scotland · January to March 2026
All cancers; the standard is 95 percent.
Sources: Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (2026)
Breast cancer registrations (persons)
3,082 (2022); 8,391 (2020-2022)
Wales · 2020-2022
WCISU geography table, Wales, one-year and three-year rows; the 2020 count (2,345) reflects the pandemic year.
Sources: Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, geography data table (xlsx, February 2026) (2026-02)
Diagnosed at an early stage (I or II)
83% (around 1,900 a year)
Wales · 2017-2019
Sources: Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24)
Female breast cancer, cases a year
1,516 (2019-2023); 1,530 in 2023
Northern Ireland · 2019-2023
Median age at diagnosis 63; stage I 43 percent, II 39 percent, III 10 percent, IV 5.5 percent of 2019-2023 cases.
Sources: Northern Ireland Cancer Registry: female breast cancer data tables 1993-2023 (xlsx, Tables 1, 7 and 12) (2026-09-24)
Five-year net survival, female breast cancer
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 83.2% (81.4-85.0) five-year net survival, female breast cancer (Northern Ireland, patients in the 1993-2023 series (Table 12)).
Northern Ireland · patients in the 1993-2023 series (Table 12)
Sources: Northern Ireland Cancer Registry: female breast cancer data tables 1993-2023 (xlsx, Tables 1, 7 and 12) (2026-09-24)
Urgent breast referrals seen within 14 days
7.9% (306 of 3,890)
Northern Ireland · January to March 2026
31-day target met for 87.3 percent; 62-day figures withheld for validation.
Sources: Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (14-day breast, 31-day and 62-day targets) (2026)
Support in the UK
Charities focused on this cancer, the general cancer charities, and the official schemes that help with costs. Each link goes to the organisation's own page.
Charity
- Free nurse helpline 0808 800 6000
- Someone Like Me: one-to-one peer support
- Moving Forward courses after treatment
- Online forum
- Information on triple negative breast cancer, olaparib, prostheses and reconstruction
Charity
- Support line and information on triple negative breast cancer
- Macmillan Grants (one-off payments)
- Benefits advice and welfare rights
Charity
- Free practical and emotional support in centres beside NHS cancer hospitals across the UK
- Support for family and friends
Triple Negative Breast Cancer Foundation
Charity- Helpline and information specific to triple negative disease
- Research grants
- Metastatic TNBC community
Free NHS prescriptions
NHS- England: a five-year medical exemption certificate for anyone with cancer or the effects of cancer or its treatment (apply through the GP or hospital); Scotland, Wales and Northern Ireland: prescriptions are free for everyone
Wigs and fabric supports
NHS- England: an NHS wig or surgical bra is free for hospital inpatients, people on qualifying benefits or with an HC2 certificate; otherwise the charges are £80.15 for a stock modacrylic wig, £212.35 for a partial human hair wig, £310.55 for a full bespoke human hair wig and £32.50 for a surgical bra
Breast prostheses on the NHS
NHS- NHS patients do not pay for a breast prosthesis, for a replacement when it wears out or for a refit when it no longer fits; not every style is available on the NHS
Healthcare Travel Costs Scheme
Cost and benefit- Refund of travel costs to NHS treatment for people on qualifying benefits or the Low Income Scheme
Personal Independence Payment and the special rules
Cost and benefit- PIP (under State Pension age) for the daily-living and mobility effects of treatment; under the special rules for end of life (12 months or less on an SR1 form) the claim is fast-tracked at the higher rate without an assessment
More schemes by country on Assistance; costs of care on Costs.
Across the four nations
Where England, Scotland, Wales and Northern Ireland run different rules for the same step.
| Topic | England | Scotland | Wales | Northern Ireland |
|---|---|---|---|---|
| Breast screening ages Sources: GOV.UK: NHS breast screening programme overview (England; last updated 18 May 2026) (2026-05-18); NHS: breast screening (mammogram) (2026-09-24); Public Health Scotland: Scottish breast screening programme statistics, annual update to 31 March 2023 (women aged 50-70) (2026-09-24); Public Health Wales: breast screening (Breast Test Wales) (2026-09-24); nidirect: breast screening overview (Northern Ireland) (2026-09-24) | Women aged 50 up to their 71st birthday, every three years; women over 71 can ask to be screened. | Women aged 50-70, every three years (711,189 invited in 2020-2023, uptake 75.9 percent). | Women from 50 up to their 70th birthday, every three years, first invitation before the 53rd birthday; women 70 and over can ask Breast Test Wales for an appointment. | Women aged 50-70 registered with a GP, every three years; invitations stop after 70. |
| Waiting-time standards Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (the page answered 202 with an empty body to OnCo on 24 September 2026; wording carried from the same day's gallbladder pass) (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (202 to OnCo on 24 September 2026) (2025-01); Scottish Government: NHSScotland performance against LDP standards, cancer waiting times (31 and 62 days, 95%) (2026-09-24); Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (2026); Welsh Government: suspected cancer pathway quality report (2026-09-24); Department of Health (Northern Ireland): cancer waiting times (2026-09-24); Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (14-day breast, 31-day and 62-day targets) (2026) | 28-day Faster Diagnosis Standard (75 percent, 80 percent by March 2026); 31 days from decision to treat (96 percent); 62 days from referral to first treatment (85 percent, planning target 75 percent by March 2026). The two-week wait was retired on 1 October 2023. | 62 days from urgent suspicion of cancer referral to first treatment and 31 days from decision to treat, both at 95 percent; 72.2 percent met the 62-day standard in January to March 2026. | Single Suspected Cancer Pathway: 62 days from the point of suspicion to first definitive treatment (the clock starts at suspicion, not referral). | A 14-day target for urgent breast referrals to be seen (7.9 percent in January to March 2026), 31 days from decision to treat (87.3 percent) and 62 days from urgent GP referral (figures withheld for validation). |
| Who decides drug funding, and where they disagree Sources: Scottish Medicines Consortium: medicines advice, triple negative (2026-09-24); Welsh Government: the New Treatment Fund (medicines recommended by NICE and the AWMSG made available within 60 days); All Wales Therapeutics and Toxicology Centre: AWMSG in relation to NICE (2026-09-24) | NICE technology appraisals, commissioned by NHS England; all triple-negative medicines recommended so far are routine commissioning. Trastuzumab deruxtecan for HER2-low disease is not recommended (TA992). | Scottish Medicines Consortium: pembrolizumab (early and metastatic), sacituzumab govitecan, atezolizumab, olaparib (adjuvant and metastatic), talazoparib and trastuzumab deruxtecan for HER2-low disease (SMC2608) are all accepted. | Follows NICE within 60 days through the New Treatment Fund; the AWMSG appraises medicines NICE will not. | The Department of Health endorses NICE appraisals for the HSC. |
| Genomic testing route Sources: NHS Genomics Education Programme, GeNotes: patient with breast cancer (R208 criteria, TP53 R216, WGS pilot M234; last reviewed 5 February 2024) (2024-02-05); GeNotes: genomic testing in the devolved nations (2026-09-24) | National Genomic Test Directory codes R208 (BRCA1, BRCA2, PALB2, ATM, CHEK2), R216 (TP53) and the M234 whole genome sequencing pilot for triple-negative disease, through seven Genomic Laboratory Hubs; eligibility for R208 includes triple-negative breast cancer under 60. | Scottish genomic laboratories in Aberdeen, Dundee, Edinburgh and Glasgow under Scotland's own test directory. | All Wales Medical Genomics Service (AWMGS) laboratory in Cardiff, with its own test list and request forms. | Northern Ireland Regional Molecular Diagnostics Service, Belfast, for germline and tumour testing. |
| Cancer statistics for breast cancer Sources: NDRS: Cancer Registration Statistics, England 2023 (the page answered 403 to OnCo on 24 September 2026); Cancer Research UK: breast cancer statistics (key stats, stage, routes to diagnosis and treatment by nation) (2026-09-24); Public Health Scotland open data: annual cancer incidence, Scotland-level CSV (opendata_inc0024_scotland.csv, modified 18 August 2026) (2026-08-18); Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, geography data table (xlsx, February 2026) (2026-02); Northern Ireland Cancer Registry: female breast cancer data tables 1993-2023 (xlsx, Tables 1, 7 and 12) (2026-09-24) | NDRS Cancer Registration Statistics (the 2023 release answered 403 to OnCo); Cancer Research UK carries the England stage, route and treatment figures used here. | Public Health Scotland: open data CSVs by site and sex (female breast 5,208 in 2024) and the annual incidence report. | WCISU (Public Health Wales): counts by cancer type, geography and year as spreadsheets (breast 3,082 in 2022). | Northern Ireland Cancer Registry: female breast cancer tables with stage and survival (1,516 a year, 2019-2023). |
| Prescription charges Sources: NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment) (2026-09-24); NHS inform: prescription charges and exemptions (prescriptions in Scotland are free) (2026-01-07); Welsh Government: free prescriptions (2020-09-18); nidirect: help with health costs (prescriptions in Northern Ireland are free) (2026-09-24) | Charged per item unless exempt; anyone being treated for cancer or its effects gets a five-year medical exemption certificate. | Free for everyone. | Free for everyone registered with a Welsh GP and dispensed in Wales. | Free for everyone. |
| Benefits under the special rules for end of life Sources: GOV.UK: get benefits if you're nearing the end of life (special rules, 12 months or less) (2026-09-24); nidirect: benefits if you are nearing the end of life (2026-09-24); GOV.UK: Personal Independence Payment (2026-09-24) | PIP or Attendance Allowance fast-tracked at the higher rate, no assessment, when a clinician says 12 months or less (SR1 form). | Adult Disability Payment through Social Security Scotland instead of PIP; GOV.UK notes different special rules apply in Scotland. | As England (DWP). | The same 12-month test through the Department for Communities. |
What could not be sourced
Named gaps, so a missing figure is never mistaken for a zero.
- The share of UK breast cancers that are triple-negative is a charity figure (Breast Cancer Now, Cancer Research UK and Macmillan all say around 15 percent, Breast Cancer Now more than 8,000 women a year). No registry publishes it: the NDRS Cancer Registration Statistics page answered 403 to OnCo, the Public Health Scotland open data carries no receptor field, the WCISU tables are by ICD-10 site only, and the Northern Ireland Cancer Registry's female breast tables have stage and histology but not receptor status. The nearest official sources are the two England registry papers cited (Møller 2016; Gathani 2021), which report receptor status as odds ratios and hazard ratios, not as a national share.
- Route to diagnosis and stage by receptor status are not published anywhere in the UK, so the statement that triple-negative cancers are less often screen-detected rests on their younger age profile (Cancer Research UK) rather than a UK figure.
- NHS England's pages (cancer waiting times standards from 1 October 2023, the 2025/26 planning guidance, the National Genomic Test Directory publication page and the national Cancer Drugs Fund list) answered HTTP 202 with an empty body to OnCo's requests on 24 September 2026, with plain and browser-like headers. The waiting-time standards are quoted as the same day's gallbladder pass recorded them; the Test Directory criteria come from GeNotes' summary; CDF status is inferred from each appraisal's own recommendation wording.
- The National Genomic Test Directory's current version number, and whether a somatic breast panel code exists for triple-negative disease beyond the M234 whole genome sequencing pilot, could not be confirmed for the reason above.
- Whether adjuvant capecitabine for residual disease after neoadjuvant chemotherapy (CREATE-X) is funded in a given trust or health board could not be sourced: it has no NICE appraisal and no national protocol was read.
- NICE's position on olaparib for metastatic germline BRCA breast cancer (OlympiAD) and the SMC's position on eribulin were not read on this pass; the SMC accepted olaparib for that use in February 2025 (SMC2737).
- No NICE appraisal for first-line sacituzumab govitecan (ASCENT-03, ASCENT-04) was found; the two datopotamab deruxtecan appraisals (ID6435, ID6643) are awaiting development with no expected publication date.
- The ISRCTN registry answered its holding page to automated requests, so PHOENIX (ISRCTN47127434) is linked through Be Part of Research; Be Part of Research's own search results and trial pages render in the browser only, so trial statuses and site lists were read from the ClinicalTrials.gov records instead.
- The Institute of Cancer Research's trial pages for TNT and PHOENIX answered 403 to OnCo; TNT is cited from the Nature Medicine paper and Be Part of Research.
- No national directory of NHS breast units was read (the Association of Breast Surgery's directory was not tried), so the centres listed are those with a public breast page or a registered triple-negative trial site, not a complete list. Manchester's Nightingale Centre (Manchester University NHS Foundation Trust) was not fetched and is not listed.
- Black Women Rising, the UK charity for Black women with cancer (relevant because triple-negative disease is more common in Black women), answered 403 to OnCo and is not listed; the Triple Negative Breast Cancer Foundation listed here is a United States charity.
- Wig and prosthesis charges are given for England only; the equivalent Scottish, Welsh and Northern Irish pages were not read.
- Public Health Scotland's breast cancer Quality Performance Indicators (patients diagnosed 2021-2023) were located but the summary spreadsheet was not opened; it may carry the proportion of ER-negative or HER2-negative cancers for Scotland.
- Professor Ellen Copson's University of Southampton profile page rendered in the browser only; her role and history are taken from the University Hospital Southampton consultant page, and her title from the University page's heading.
How to read this page. Every figure and decision links to the page it was read from (101 sources, checked 2026-09-24); the drug and trial pills open OnCo records with their own sources. Standards and funding change: confirm with your team and the linked pages. Machine-readable copy at /api/v1/cancers/tnbc/uk.json. OnCo is orientation, not medical advice.