@mswendeu I had a .7 cm lesion at 9 o’clock, 9 cm from nipple. I had mammogram, US, and then an US supported core needle biopsy (not stereotactic).
The percentage of lesions found by mammogram that are cancer are low, but a Birad 4 has a higher percentage. If I were you, I’d have the biopsy. And expect an MRI follow up. I did not have pain with my biopsy, except the initial injection of lidocaine (like at the dentist office). I’ve now had 4 MRIs with no problems, although maneuvering onto the table is interesting.
I had a lumpectomy using breast conserving surgery, tissue was adjusted so there is no depression (divot) where the lesion was removed. I chose 5 day radiation, although today it is sometimes an option to have none. I’m on 5mg tamoxifen even though I’m postmenopausal.

As you make decisions it’s important to pay attention to the biopsy and later pathology. The grade is informing, mine was intermediate. The grade is an indication of 3 measures. The type cell is important, mine was 3 types, cribriform (not too bad), papillary (not too bad), solid (not good). Comedo vs noncomedo is important. “Comedo” - if you think about acne and a comedone, it’s similar. It’s a small bump. It indicates a higher collection of cells - and in breast cancer more often cancer cells. Cancer.org and Komen.org are just a couple of the good cancer sites to give you more info.

Check to see if they recommend taking Tylenol or other pain reliever before the biopsy. They sometimes do - if they decide they need to look at lymph node involvement then I understand it’s more comfortable taking Tylenol before.