Nonpalpable breast lesions: biopsy methods and patient management

Mammography has become a major, if not the best available, diagnostic tool for the early detection of breast cancer. Screening has progressed substantially from the anecdotes of physicians in the early 1970s, that is, the assumption that "if I can't feel it, it's not there." Although controversy continues regarding the earliest age at which screening mammography truly lowers the death rate from breast cancer, the fact that mammography detects breast cancer years before it might be discovered as a mass in the breast cannot be challenged. Mammographic techniques have improved to the point at which smaller and smaller areas of suspicion can be identified, and mammographers have gained greater experience in the interpretation of these minute radiographic abnormalities. The ability to detect these changes has inevitably led to an increase in procedures designed to explain them. The incurred costs, both emotional and economic, of patient recalls for positive mammographic findings are considerable. Regardless of whether the physician practices medicine as a patient advocate or exercises politically correct and cost-effective mandates, the management of nonpalpable breast lesions requires the correlation of cognitive and procedural skills and cooperation among physicians and reflects the technical achievements of contemporary medicine.