What is the BI-RADS Score and What Does it Mean?

When you have a mammogram, breast ultrasound, or breast MRI, a report is produced by the radiologist who reviewed the images. The report will include a Breast Imaging Reporting and Data System (BI-RADS) score. Along with the radiologist’s analysis, the BI-RADS score helps your doctor understand what was found in the images and the best next steps.

Why Is Getting Screened for Breast Cancer So Important?

Breast cancer symptoms usually do not appear until the cancer has reached a more advanced stage. Often, the first noticeable symptom is a lump that can be felt. Routine screening allows for earlier detection of breast cancer, making it easier to treat. Prompt treatment allows for significantly better outcomes.

The American Cancer Society recommends that women at average risk begin screening at age 45. If there is a family history of breast cancer or other associated risk factors, screening may need to start earlier. Your doctor can help you determine the right time for screening.

Screening Tests Used for Breast Cancer Detection

• Mammogram: This is the standard screening test for breast cancer. 3-D mammography tends to be more effective than two-dimensional (2-D) mammography, particularly in women with dense breast tissue. Be sure to ask the breast imaging center if 3-D mammography is available.

• Breast MRI: Women at high risk may be screened with a breast MRI in addition to a mammogram, since it can detect some cancers that a mammogram might miss.

• Breast ultrasound: This test is used in specific situations to examine changes in the breast, such as lumps, and to provide a closer look at dense breast tissue. Breast ultrasound is usually performed in addition to mammography.

Breast screening tests are often conducted by a technician and then evaluated by a radiologist who specializes in reviewing breast images. A BI-RADS score will be assigned based on their findings.

Understanding the BI-RADS Score

The Breast Imaging Reporting and Data System (BI-RADS) provides a universal method for breast cancer specialists to describe patient screening results. Generally, only patients with abnormal imaging results will be told about their BI-RADS score.

Components of the BI-RADS Score

The BI-RADS score has two components:

1. Categories

2. Breast density

BI-RADS Categories

The BI-RADS score categories range from 0 to 6 as follows:

• 0: Incomplete imaging. Additional testing is needed because the images were unclear and did not provide definitive results. Sometimes, a new mammogram can be compared with an older one to check for any changes.

• 1: Negative for Breast Cancer. A normal test result indicates no new or abnormal findings.

• 2: Benign finding. Something was detected, but it is not cancerous (benign). This may be scar tissue or a change in tissue following a previous surgery. The radiologist will note it as a noncancerous finding to avoid confusion on future tests.

• 3: Probably benign (non-cancerous) finding. An abnormal growth was found that is more likely to be benign than cancerous. A follow-up scan with mammography is needed in 6 to 12 months to determine whether it has changed or remains stable. Early diagnosis may be possible with continued monitoring if changes are seen over time.

• 4: Suspicious abnormality. A score of 4 does not indicate cancer, but it does mean more testing is required, such as a biopsy. This category is further divided into:

  • 4A: Findings with a low likelihood of cancer, around a 2% to 10% chance.

  • 4B: Findings with a moderate likelihood of being cancer, about a 10% to 50% chance.

  • 4C: More concerning findings, with a high likelihood (about 50% to 95%) that the growth is cancerous.

• 5: Highly suggestive of cancer. There is a 95% or higher chance that the growth is cancerous. A follow-up tissue biopsy will be recommended to confirm the diagnosis.

• 6: Known malignancy confirmed by biopsy. This category is sometimes used to monitor how well cancer responds to treatment.

BI-RADS Breast Density

A BI-RADS score also describes breast density, which is the amount of fibrous and glandular tissue in the breasts compared to fatty tissue.

• Category A: Almost all fatty breast tissue

• Category B: Scattered areas of dense glandular and fibrous tissue within the breast

• Category C: The majority of the breast is dense glandular and fibrous tissue

• Category D: Almost all dense breast tissue

Denser breast tissue can make it more difficult to detect abnormal areas on a mammogram, which slightly increases the risk of breast cancer. In cases such as this, the doctor may suggest other types of imaging as part of the screening process.

Why the BI-RADS Score Is So Important

Your BI-RADS score guides your doctor on the next steps to take. A low score is a good thing, allowing you to continue with routine check-ups. On the other hand, higher scores suggest an abnormal growth is present, which requires further imaging and possibly a breast biopsy to determine if the mass is cancerous.

Breast cancer screening is a vital practice that can save lives. It's important not to skip these screenings and to encourage others to get screened.

Treatment After a Breast Cancer Diagnosis in Brevard County, Florida

Cancer Care Centers of Brevard offers the latest breast cancer treatments. Our breast cancer doctors are here to provide you with an individualized treatment plan. If you were recently diagnosed with breast cancer, schedule a consultation with one of our oncologists. We serve several areas in Florida, including Melbourne, Merritt Island, Rockledge, and Palm Bay.

Categories: Breast Cancer