Management of clinically occult (nonpalpable) breast lesions

In the past generation, mammography has become a major, if not the best available, diagnostic tool for the earlier detection of breast cancer. We have certainly come far from hard-to-imagine anecdotes of the early 1970s that "if I can't feel it, it's not there!" Although current controversy questions the earliest age at which screening mammography truly lowers the death rate from breast cancer, that mammography does detect breast cancer years before it might be discovered as a mass in the breast cannot be challenged. Mammographic techniques have improved so that smaller and smaller areas of suspicion may be identified, and mammographers have gained greater judgment in the interpretation of these minute radiographic abnormalities. This has inevitably led to an increase in procedures designed to explain them. The incurred costs, both emotional and economic, of positive mammographic "calls" are considerable. Whether practicing medicine as patients' advocates or, as unfortunately currently seems to be of equal importance, exercising politically correct and cost-effective mandates, the management of nonpalpable breast lesions certainly bears witness to the correlation of cognitive and procedural skills and cooperation between physicians, as well as the technical achievements of contemporary medicine.