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Prior mantle/chest radiation before age 30 confers high lifetime breast cancer risk comparable to some hereditary syndromes. Enhanced surveillance is recommended: annual contrast-enhanced breast MRI beginning 8 years after radiation or by age 25 (whichever is later) and addition of annual mammography at age 30. Alternating MRI and mammography every 6 months helps detect interval cancers. MRI detects invasive cancers in dense post-radiation breasts; mammography adds microcalcification detection. Deferring to age 40 (Option A) misses a prolonged high-risk window. Symptom-based screening (Option C) forfeits early detection. Ultrasound (Option D) is not a substitute for MRI/mammography in this population. APRNs coordinate imaging logistics, counsel on breast self-awareness, review reproductive/endocrine history (e.g., prolactin, fertility, pregnancy timing), and discuss risk-reduction strategies such as lifestyle modification and, in select cases, chemoprevention or risk-reducing surgery after genetics evaluation. Ensure prior radiation details are captured in the survivorship plan and communicate with primary care to maintain adherence and follow-up of findings.