Ans. is 'b' i.e. History of previous radiation Conservative breast cancer management: Absolute Contraindications Pregnancy is an absolute contraindication to the use of breast irradiation. However, in many cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with irradiation after delivery. Women with two or more primary tumors in separate quadrants of the breast or with diffuse malignant-appearing microcalcifications are not considered candidate for breast conservation treatment. A history of prior therapeutic irradiation to the breast region that would require retreatment to an excessively high total-radiation dose to a significant volume is another absolute contraindication. Persistent positive margins after reasonable surgical attempts. Relative Contraindications A history of collagen vascular disease is a relative contraindication to breast conservation treatment because published repos indicate that such patients tolerate irradiation poorly. Most radiation oncologists will not treat patients with scleroderma or active lupus erythematosus, considering it an absolute contraindication. In contrast, rheumatoid ahritisis not a relative or an absolute contraindication. The presence of multiple gross tumors in the same quadrant and indeterminate calcifications must be carefully assessed for suitability because studies in this area are not definitive. Tumor size is not an absolute contraindication to breast conservation treatment, although there is little published experience in treating patients with tumor sizes greater than four to five cm. However, a relative contraindication is the presence of a large tumor in a small breast in which an adequate resection would result in significant cosmetic alteration. In this circumstance, preoperative chemotherapy should be considered. Breast size can be a relative contraindication. Large pendulous breast is a relative contraindication, as it presents difficulty in delivering a uniform radiation dose. Centrally located tumor for which removal of the nipple areola complex is required to obtain a tumor free margin is a relative contraindication. It depends on patient acceptability. The nipple and areola can now be reconstructed.