Childhood and young adult survivors of Hodgkin lymphoma are at an elevated risk of developing breast cancer [[1], [2], [3]]. Breast cancer risk is felt to originate from chest wall radiation exposure prior to the third decade of life, with incidence beginning to rise approximately eight to ten years following Hodgkin lymphoma treatment. Although incidence varies according to age at radiation exposure, dosage, and treatment fields, cohort studies have documented a cumulative incidence of breast cancer of 10–20% by 40 years of age [[4], [5], [6]]. This level of risk mirrors that of BRCA1/2 carriers, for whom enhanced surveillance with alternating mammography and bilateral breast MRI every 6 months is standard, along with consideration of risk reducing mastectomy [4,7]. Similarly, women with a history of chest radiation for Hodgkin lymphoma are counselled to begin screening with bilateral breast MRI at 25 years of age, or eight years after radiation, whichever occurs later [[8], [9], [10]]. Outside of high-risk surveillance, the optimal management approach for women with prior radiation exposure continues to evolve [11]. Early detection remains important, as studies have demonstrated poorer overall survival outcomes in Hodgkin lymphoma survivors relative to women with de novo breast cancer [12]. When diagnosed with breast malignancy, evidence supports consideration of unilateral therapeutic and contralateral prophylactic mastectomy, although breast conserving surgery may be considered following multidisciplinary assessment [13,14]. This review will address the epidemiology, characteristics, screening and management guidelines, and breast-cancer prevention efforts for Hodgkin lymphoma survivors treated with radiation therapy in adolescence and young adulthood.