This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Endocrinology and breast, Subject name: Surgery
In carcinoma breast, adjuvant radiotherapy is indicated after modified radical mastectomy in all of the following except 
Select and explain. 
A. ER, PR hormone receptor negative tumour, B. Tumour size more than 5 cm, C. Positive margins, D. More than four positive axillary lymph nodes
A: ER, PR hormone receptor negative tumour
Answer: A: ER, PR hormone receptor negative tumour 
Explanation: .Radiotherapy in carcinoma breast Indications: * Patient who undergo conservative breast surgery, breast is irradiated after surgery * After total mastectomy, external irradiation is given to axilla. * Patients with higher risk of local relapse after surgery: a. Invasive carcinoma. b. Extensive in situ carcinoma. c. Patients under 35 years. d. With multifocal disease. * In bone secondaries, to palliate pain and swelling. If there is pathological fracture in the bone, internal fixation has to be done along with external irradiation. * Inflammatory carcinoma of breast. * In atrophic scirrhous carcinoma of breast, as a curative radiotherapy. * As preoperative radiotherapy, to reduce the tumour size and downstage the tumour, so that the operability is better. * More than 4 positive lymph nodes in the axilla, pectoral fascia involvement, positive surgical margins, extranodal spread or in patients with axillary status not known/not assessed. ref:SRB&;s manual of surgery,ed 3,pg no 485