The recipient of the 2018 Cancer Research Excellence in Surgical Trials (CREST) Award is the Breast Surgery Team at Queen Elizabeth Hospital NHS Foundation Trust, King’s Lynn. As a smaller District General Hospital in a rural area, it is impressive to see the high number of patients recruited across a portfolio of many breast cancer trials. These trials include interventional studies such as POSNOC, PRIMETIME and ADDASPIRIN and the numbers of patients recruited to the NIHR portfolio matches or exceeds many larger hospitals. The team also screen patients for other trials, directing them where possible to neighbouring larger trusts in order to improve access for their patients to other complex trials with demanding inclusion criteria. They have shown a significant contribution to the health of their local population, and also to the national collaborative efforts to enhance outcomes for patients with breast cancer. The Crest Commendations for 2018 have excelled in trial recruitment but also in areas of innovation and leadership. Firstly to the Thames Valley South Midlands Direct Delivery Team, who have implemented a novel approach over the last few years by creating a distinct team across their region to deliver the surgical portfolio. In doing so they have greatly increased recruitment and access to trials for patients. We also have awarded a CREST Commendation to the General Surgery Research Team based at the Queen Elizabeth Hospital Birmingham. Not only have they demonstrated consistently impressive trial recruitment, but also have shown great leadership locally, regionally and nationally in educational and trainee-led initiatives in surgical trial recruitment.