Contraindications to Breast Conservation Therapy


  • Pregnancy (Pregnancy and Breast Cancer)
    • Unless terminated, pregnancy is an aboslute contraindication to radiation therapy because of the possible teratogenic and carcinogenic effects on the fetus.
  • Collagen vascular disease
    • Some studies show higher risk of necrosis and fibrosis : Scleroderma [Ref. Ross, Chen AM, Phan C], Mixed connective tissue disorder [Ref. Ross, Chen AM, Phan C], CREST syndrome [Ref. Ross, Chen AM, Phan C]
    • Collectively there does not appear to be significantly greater late complication rate associated with CVD. (Perez 3rd ed. p1238).
    • It is prudent to limit the whole-breast dose t 45 Gy with 1.8 Gy fractions use 6-MV photons.
  • Multicentric Disease[Ref. Park CC]
    • Disease in multiple quadrants
  • Persistently positive diffuse margins


  • Prior Treatment with Radiation Therapy
    • Not an absolute contraindication (see reirradiation section in Local Recurrence)
  • Lupus and Rheumatoid Arthritis
    • 3 studies performed a formal comparison of patient with rheumatologic disease.[Ref. Ross, Chen AM, Phan C]
  • Genetic Factors (ATM, BRCA-1 and BRCA-2 mutations)
    • No evidence that mastectomy improves breast-cancer-specific survival over breast-conserving therapy
    • Heterozygots for ATM, BRCA1, and BRCA2 do not have higher risk of developing irradiation related toxicity compared to normal individuals. However, having two ATM mutations may be more sensitive than normal individuals.
    • Finding of an abnormal breast-cancer linked gene should not be considered a contraindication to breast-conserving therapy
  • Tumor size > 4 to 5 cm
    • Difficult to achieve acceptable cosmetic rsults
    • Neoadjuvant chemotherapy may sometimes allow the use of breast-conserving therapy
  • Focally involved Margin[Ref. Park CC]
    • Ideally patiens with involved or positive margins should undergo further surgery before starting radiation therapy.


  • Young women
    • Among women age < 35 years at diagnosis who receive BCT, 10-year local recurrence rates of 30% have been reported, compared with local recurrence rates of < 10% among middle-aged and older women
    • Despite having a higher rate of local recurrence, young women with breast carcinoma who receive breast-conserving therapy are similar to young women treated with radical mastectomy in terms of survival. [Ref. Kroman]
  • Multifocal Disease
    • Multiple foci within same quadrant and is not contraindication to breast-conserving therapy
  • Bilateral Breast Cancer
    • both synchronous or metachronous breast cancers can be treated without an increased risk of complications
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