From the Guidelines
The correct answer is (d) collagen vascular disease. Collagen vascular disease is a contraindication to breast-conserving therapy because patients with these conditions (such as systemic lupus erythematosus, scleroderma, or rheumatoid arthritis) often have abnormal tissue healing and increased sensitivity to radiation therapy 1. When these patients receive radiation as part of breast conservation, they are at higher risk for severe skin reactions, fibrosis, and poor cosmetic outcomes. The radiation can exacerbate their underlying autoimmune condition, leading to significant complications. In contrast, advanced age (a), coronary artery disease (b), and family history of breast cancer (c) are not contraindications to breast-conserving therapy. These factors may influence overall treatment planning but do not specifically prevent a patient from being a candidate for breast conservation with radiation therapy. According to the most recent study 1, relative contraindications to lumpectomy include previous radiation therapy to the breast or chest wall, active connective tissue disease involving the skin (especially scleroderma and lupus), tumors greater than 5 cm, and positive pathologic margins. Some key points to consider are:
- Collagen vascular disease is a contraindication due to increased risk of complications from radiation therapy 1
- Advanced age is not a contraindication, and whole breast irradiation may not be necessary in selected women aged 70 years or older 1
- Family history of breast cancer and coronary artery disease are not contraindications to breast-conserving therapy 1
From the Research
Contraindications to Breast-Conserving Therapy
- A contraindication to breast-conserving therapy is:
- (d) collagen vascular disease As studies have shown that patients with collagen vascular disease, particularly scleroderma, are at a higher risk of developing severe complications from radiation therapy, such as fibrosis 2, 3, 4.
- The following options are not considered contraindications to breast-conserving therapy:
- (a) age more than 70 years
- (b) coronary artery disease
- (c) family history of breast cancer These factors may influence the decision to undergo breast-conserving therapy, but they are not absolute contraindications 5, 6.
Specific Considerations
- Collagen vascular disease, particularly scleroderma, is a relative contraindication to breast-conserving treatment due to the potential for severe complications from radiation therapy 2, 3, 4.
- Other factors that may influence the decision to undergo breast-conserving therapy include the size and location of the tumor, the presence of multifocal or multicentric disease, and the patient's overall health and preferences 5, 6.