What to Know About Your BI-RADS Score

Medically Reviewed by Murtaza Cassoobhoy, MD on May 26, 2023
4 min read

BI-RADS stands for Breast Imaging Reporting and Data System. It is an assessment tool used to rate the results of a mammogram test.

The BI-RADS score has seven levels of ranking:

  • Category 0: Additional imaging is needed to provide a category. The results were inconclusive.
  • Category 1: Your test result is negative. There is no significant or noticeable abnormality from your mammogram. It is important to continue screening at regular intervals.
  • Category 2: A noncancerous growth was identified. There is a benign calcification or fibroadenoma, but it is not of concern. Continue receiving regular mammograms.
  • Category 3: A growth was identified that is most likely benign. You should receive mammograms more frequently (at six-month intervals) to monitor the area for changes.
  • Category 4: There is a suspicious abnormality that may be cancerous. This result requires a biopsy
  • Category 5: The growth is highly likely to be malignant, meaning it is probably cancer. This result requires a biopsy. ‌
  • Category 6: A biopsy confirms the results of your mammogram, and the growth is identified as cancer. Treatment should begin immediately.

It also assesses your overall breast tissue density. With more dense breast tissue, growths may be more difficult to identify. You’re also at a greater risk for growths with more dense breast tissue. A mammogram may help predict your chance of developing breast cancer in the future.

A mammogram is an X-ray of your breast tissue used to identify breast cancer. You stand in front of an X-ray machine, placing your breast on a plate. An X-ray technician ensures proper placement and then presses your breast from above with a second plate.

You may feel pressure, discomfort, and even pain during the X-ray. Once one side is complete, the technician scans your second breast. Your breasts may be sore or sensitive following the procedure.

The technician doesn’t read your results during the exam. Instead, they are read and translated by a special doctor called a radiologist who shares the results with you using the BI-RADS scoring system.

Next steps. If your BI-RADS score indicates an abnormal growth that may be cancer, the radiologist refers you to a breast or surgical specialist for a biopsy. This procedure is used to remove a small sample of the breast tissue in question for laboratory testing.

Following the procedure, your doctor has access to a detailed report that outlines any concerns raised by the tissue sample. Aside from mammogram results, you may also need a biopsy if:

  • Your doctor feels a lump on your breast
  • An ultrasound shows something of concern
  • An MRI scan shows an area of concern‌
  • You have unusual nipple changes like crusting, scaling, dimpling, or discharge

Surgery. After receiving a breast cancer diagnosis, it is important to undergo treatment as soon as possible to ensure the best outcome. Your treatment usually involves surgery to remove the affected breast tissue.

Before surgery, your doctor may recommend chemotherapy or radiation to shrink the tumor and affected lymph nodes. This also provides an indication of how your body responds to treatment.

Breast surgery may involve a lumpectomy to remove the tumor and some surrounding normal tissue to make sure that all of the cancer is gone. This approach is used for cancer in early stages, when tumors are small. You may need radiation following the surgery.

A mastectomy is used to remove your entire breast. Some surgery techniques spare your breast skin, areola, and nipple for future reconstruction surgery. If you have a high likelihood of future cancer, your doctor may perform a double mastectomy and remove both breasts.

Once the breast tissue is removed, more laboratory tests are done. Your doctor may want to test your lymph nodes to see if the cancer has spread, which may mean other organs could be affected in the future.

Radiation. This therapy uses powerful energy beans to shrink tumors prior to surgery or kill remaining cancer cells after surgery. A radiologist performs this therapy on you daily for up to six weeks. For metastatic breast cancer that spreads to other areas of your body, radiation therapy may reduce your symptoms and improve your quality of life.

Proton therapy. Similar to radiation, this type of therapy uses a different energy and is more accurate at targeting specific tissue, sparing healthy tissue and organs.

Chemotherapy. Special cancer drugs are injected to destroy cancer cells or slow their growth. You may receive chemotherapy intravenously, which means it goes directly to your veins. You may also receive it orally via a tablet or liquid that you swallow.