1566 Background: The risk of developing a secondary breast cancer (SBC) among women receiving chest radiotherapy (RT) for pediatric cancer and Hodgkin lymphomas (HL) is well established. The present study analyzes the clinical characteristics, pathology, management and prognosis of BC occurring after RT. METHODS From 1980 to 2010, 80 cases of SBC in a series of 76 survivors were diagnosed. These patients were treated from 1965 to 1992 with RT +/- chemotherapy for pediatric cancer or HL at Milan Cancer Institute. The histology, grading, nodal status, hormone receptor status, stage of the SBC, type of chemotherapy and surgery, disease free and overall survival were analyzed. RESULTS The median age at diagnosis of first neoplasms and of SBC was 18 and 38 years, respectively. The main histological features and the hormone receptor status paralleled the frequency observed in the case series of primary BC treated in the same Institution in the similar period of time. 67% of the tumors had ductal histology, 62% had positive estrogen receptor, 50% presented with pN0 and 68% with pT1 tumors. The incidence of bilateral synchronous SBC was 5%. In 59% of patients (41) adjuvant chemotherapy was administered, including antracyclines in 43% of this subgroup, followed by endocrine therapy in hormone positive receptor tumors only. Conservative surgery was feasible in 43 women (56%) and despite prior chest irradiation, subsequent breast RT was delivered in 33 of them. The five year disease free survival, overall and specific BC survival were 47%, 78% and 79%, respectively. CONCLUSIONS Clinical characteristics, pathology and outcomes of SBC among this series of young women are similar to those observed in primary BC. Conservative surgery and repeat irradiation is also possible, without tissue necrosis. Despite previous therapies for their first malignancy, in a specialized institution patients with SBC can be managed in the same way as primary BC and carries similar chances of cure.