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Breast Imaging, Reporting & Data System (BI-RADS)

What is a BI-RADS score?

When a radiologist interprets a mammogram, he or she assigns a score to it used to communicate with doctors about how concerned he or she is about the findings.

Did anything look abnormal? How serious is the abnormality that was found? This and other information is efficiently summed up in one number, called the Breast Imaging Reporting and Data System (BI-RADS) score.

BI-RADS scores range from 0 to 6:
0: This score identifies a mammogram study that is still incomplete. The X-ray may have been cloudy, making it difficult to read the images. This can happen, for example, if you moved at the precise moment the picture was taken.

In any case, further information is needed to make a final assessment and assign the true BI-RADS score. If you’ve received a BI-RAD score of 0, you need to make sure that additional imaging is done, such as some extra mammography views or an ultrasound.

1: This score is good news! It means that your mammogram is negative (that is, no evident signs of cancer were found) and that you should continue to have routine screenings.

2: This score also means that your mammogram is normal, with no apparent cancer, but that other findings (such as cysts) are described in the report. You’ll be instructed to continue your routine screening.

3: Now we are entering a gray zone. A BI-RADS score of 3 means that your mammogram is probably normal but that there’s an approximately 2 percent chance of cancer. You’ll be asked to follow-up with a repeat mammogram in six months. And if you have a family or personal history of breast cancer, the radiologist may opt to do more tests now rather than wait.

4: This score means that the findings on your mammogram are suspicious. To make a diagnosis, the doctors will need to perform a biopsy to get a small tissue sample. More than 90 percent of women with a BI-RADS score of 4 can have a core biopsy performed without the need for general anesthesia or an incision in the breast. At our Breast Center, if a biopsy is warranted they are commonly performed the same day the mammogram is read. Nationally, the rate of open excisional biopsies is much higher than necessary. Our rate is very low; more than 90 percent of biopsies done here are core biopsies.

5: This score means that your mammogram results are highly suspicious, with a 95 percent chance of breast cancer. You will need to have a biopsy for diagnosis. Talk to your doctors about what course of action to take.

6: This means that you have already been diagnosed with breast cancer and the pathologist has confirmed the diagnosis.

Why should you know your BI-RADS score?

Knowing your BI-RADS score will help ensure that you get the proper follow-up after your mammogram. It is part of what you need to know to actively participate in your medical care.