In the 1930s Warren and Gates [5] proposed the first working definition of Multiple Primary Neoplasms (MPNs): (1) both tumors should be confirmed histologically as malignant; (2) each cancer must be anatomically separate and distinct; and (3) the second tumor must not be a recurrence or metastasis of the first cancer. This means that tumours arise in other organs than the independent primaries, each tumour has to be histologically distinctive and the possibility of metastasis or recurrence must be excluded [6,7]. The mechanism of development of MPNs is unclear and likely multifactorial; identified risk factors include previous cancer treatment, smoking, diet, and genetic mutations [8]. The synchronous expression of breast and cervical carcinoma is a rare event, due to various unfavorable predisposing factors [9]. With the active application of the PET/CT scanners in order to strictly define the stage of the malignant tumors, the possibilities for detecting synchronous neoplasms have risen sharply [10]. The appearance of synchronous primary neoplasms is a challenge for the treating team as it puts a number of questions about the patient's healing strategy. This is a therapeutic dilemma in everyday clinical practice [11]. Causal mechanisms of their development include the following: (i) host factors – genetic (BRCA mutations, Li-Fraumeni syndrome), hormonal, prior cancer diagnosis and treatment exposures, (ii) lifestyle factors such as alcohol and tobacco use (risk factors for several cancer types), and (iii) environmental influences – geography (areas of increased radon exposure), pathogens (human papilloma virus or Epstein-Barr virus infections) and occupational factors [12-17]. Patients with multiple primaries have less aggressive malignancies, present at earlier stages, frequently have a strong family history of similar cancer, and their cancers tend to have indolent clinical behavior with longer survival rates, possibly related to genetic predisposition [14]. Synchronous genital tract neoplasms are rare but cause more clinical problems than a single neoplasm [18,19]. Interesting clinical case with synchronous cervical carcinomas (exocervix squamous cell carcinoma and the clear cell endocervix adenocarcinoma), accounting for Human Papilloma Virus (HPV) 18, which was detected in the squamous cell carcinoma; however, without HPV in the clear cell adenocarcinoma [20]. 4-17% of patients with Breast Cancer (BC) develop multiple primary neoplasias. The most frequent type of synchronous malignancy in patients with BC is contralateral breast cancer (63.3% of cases) followed by female genital organ cancer (13.4% of cases) [6]. In the publication of L. Marinova et al. / 2015, an interesting and extremely rare clinical case of two synchronous tumors in the breast, namely invasive ductal carcinoma and primary breast osteosarcoma [21]. Most often diagnosed synchronous neoplasms are contralateral breast cancer and genital cancers, of which most common is cervical cancer [22]. Genetic factors (e.g., BRCA1, BRCA2) are seen as habitual risk factors for multiple primary tumors [23]. Published data indicate that age as well as menopausal status at breast cancer diagnosis are risk factors for development of second cancer [24-26]. Studies in Japan and Italy estimated that 9%-11% of early gastrointestinal carcinomas develop other malignancies [27,28]. Five-year survival rates were higher for metachronous cancers (95%) than for synchronous primaries (59%) and single primaries (59%) [14]. For the treatment of multiple malignancies, each case must be considered individually, ideally by a multidisciplinary team, accounting for the type and stage of each tumor, response to treatment, and the patient's overall health status [8]. In the present case, the familial history of the patient implies a high risk of malignant neoplasms as her mother had uterine cancer. Breast cancer is a socially significant, most commonly diagnosed neoplasm in women. In the current clinical case, as it is a I clinical stage BC after a conservative breast surgery, no chemotherapy is required. For stage IIA ВС, the decision was to treat her with chemotherapy followed by postmastectomy radiation therapy due to multiple risk factors, including focal lymphovascular space invasion and 2 positive lymph nodes [29].  Breast-preserving surgery with subsequent high-tech radiotherapy has a great contribution to achieving very good therapeutic and cosmetic results [30]. Adjuvant Left Breast Radiotherapy (ALBRT) for breast cancer can result in significant radiation dose to the heart [31]. As the number of BCs survivors has increased, chronic sequelae of breast cancer RT has become more important [32]. Heart-sparing can be performed in three different ways in breast cancer radiotherapy: by seeking to keep the heart out of treated volumes (i.e. by prone position or specific breathing techniques such as Deep Inspiration Breath-Hold (DIBH) and/or gating), or by using modern radiation techniques like IMRT, Volumetric Modulated Arc Therapy (VMAT) or protons [33]. Deep Inspiration Breath-hold (DIBH) is a well-established radiation technique to achieve a significant cardiac dose reduction during adjuvant Radiotherapy (RT) in left-sided breast cancer (Figure 2). A new linac system with an integrated Surface Scanner (SS) for DIBH treatments could easily be incorporated into daily routine and is associated with significant dose reduction to the heart and ipsilateral lung [34].