There are two approaches to the detection and treatment of breast cancer. A
lmost all current efforts are focused on improving the detection of small c
ancers and their treatment. Breast cancers, even when detected at their sma
llest visible size, still carry a substantial risk of claiming the life of
a patient. The alternative is to focus on the identification of cancer prec
ursor lesions. Effective identification and treatment of precursor lesions
would prevent all breast cancer deaths. This requires scientific assessment
of the effectiveness of prevention strategies in high-risk women. Certain
groups of women are known to be at high risk for development of breast canc
er. These include women with a personal and/or family history of previous b
reast cancer, women carrying certain genes, and women with atypical hyperpl
asia. Detection of atypical hyperplasia by surgical biopsy in a symptomatic
population for risk assessment is not practical. The alternative is the us
e of noninvasive procedures such as fine-needle aspiration biopsy in order
to sample and monitor the earliest changes associated with breast cancer. T
his requires adequate recognition of the cytomorphology of breast cancer pr
ecursor lesions and the ability to distinguish between prognostically relev
ant morphologic alterations and atypias associated with various benign brea
st diseases.