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Breast cancer will affect approximately one woman in nine, and it is estimated that approximately one-third of the 500,000 new cases of cancer among American women in 1993 will be cancer of the breast. With no current method of prevention available, early detection of breast cancer by regular self and physician performed breast examination in conjunction with screening mammography is emphasized. The rate of breast cancer detection has accelerated due to the ability of mammography to identify nonpalpable breast lesions. From January 1987 to January 1992, 1,323 breast biopsies were performed at Erlanger Medical Center, with 559 of these biopsies performed on 541 patients, utilizing needle localization. Of the 559 biopsies, 92 were positive for malignancy (17%). The mean patient age at detection of malignant lesions was 55.2 years. The most common mammographic abnormality leading to biopsy was an irregular breast tissue matrix (mass or density) with 25/191 (13%) biopsies positive for malignancy. The mammographic abnormality associated with the highest malignancy rate was the presence of calcifications in association with a mass or density 16/56 (29%). The upper outer quadrant (UOQ) was the most common site of biopsy 313/559 (56.0%), and biopsies from this region had the highest incidence of malignancy 67/313 (21%). Eighty-seven of the 92 patients with biopsy-proven malignancy underwent subsequent definitive surgical treatment. Tumor size did not correlate with node negative status, but evidence of microscopic invasion did. Preinvasive (in-situ) lesions were present in 23/92 biopsies (25%). There was no axillary involvement associated with in-situ carcinomas.