Mammographic Second Opinions Prior to Biopsy of Nonpalpable Breast Lesions

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Abstract
The recent report of the Council on Scientific Affairs of the American Medical Association1 summarizes the status of screening mammography as follows: "There is strong epidemiologic evidence that mammography screening in asymptomatic women aged 50 years or older reduces breast cancer mortality.. [and] suggest reductions in mortality and better survival in younger women as well." Documentation of the benefits of screening mammography makes cost the major limiting factor in large-scale adoption of this examination. Surprisingly, in this country probably less than one half of the total costs of screening mammography actually relate to the screening examination.2 The remaining "downstream" expenses relate to the false-positive mammographic diagnosis of cancer with subsequent physician consultation, roentgenographic localization, and surgical biopsy. I believe that too many breast biopsies are recommended for minimally suspicious nonpalpable lesions and that the cost of performing these biopsies jeopardizes mammography screening programs. As a partial remedy to