Breast Imaging Reporting and Data System (BIRADS)

Mammogram Details and Diagnosis

What is the breast imaging data and reporting system (BIRAD) score and what does your number mean for you personally?. Photo©giannonip

What is the BIRADS score and what does it mean about my mammogram?

Breast Imaging Reporting and Data System (BIRADS) - Definition

Your mammogram report includes many technical details, and one section will show you a Breast Imaging Reporting and Data System (BIRADS) score. This indicates the radiologist's opinion of the absence or presence of breast cancer. It's good to know why this score is important to your diagnosis and treatment if any will be needed.

Discuss your results with your doctor to make sure you understand what it means for your breast health.

BIRADS was developed by the American College of Radiologists as a standard of comparison for rating mammograms and breast ultrasound images. It sets up a classification for Level of Suspicion (LOS)-- the possibility of breast cancer.

Getting Your Results

After your mammogram or breast ultrasound, a radiologist will read the image and write a report, giving an opinion on your breast health.

Many people think of mammograms as being "yes-no" types of reports.  That is not the case as can be seen on the classification below, and there are many in between or gray areas that are found on mammograms.  In being your own advocate in your health care it is important that you both receive a copy of your results, and discuss exactly what your mammogram describes.

What Does Your Number Mean to You?

You BIRAD score will give you a number of 0 to 6 in which findings on your mammogram are described, but what does that mean for you personally?

  • Scores of 0 to 2 "look okay" and describe reports in which either nothing abnormal is seen, or that any abnormalities seen by the radiologist appear to be benign breast conditions.  This does not mean that you are not at risk for breast cancer or could not have breast cancer. It's important to note that breast cancer can be present with a completely normal mammogram, and this happens not infrequently.  If your mammogram score is in this category, it is still important to have a clinical breast exam at a frequency determined by you and your physician.  It is also important to follow up any abnormalities you have noted yourself on self-breast exams.
  • Scores of 3 to 5 will require some follow-up.  This may include further views, a breast ultrasound, a breast MRI, a form of breast biopsy, or a combination of these tests or others.
  • A score of 6 is given only after a biopsy has been examined and found to be cancerous.  In this case, treatment would definitely be required.

BIRADS Classifications:

The individual categories are described here, plus compiled in a table below so you can visualize the differences:

Category 0 -- Incomplete
Your mammogram or ultrasound didn't give the radiologist enough information to make a clear diagnosis. Don't worry, this may mean that scar tissue from a previous surgery or biopsy may have shown up, or that a breast lump that is big enough to be easily felt isn't imaging clearly. You will need to have a follow-up image done.

Category 1 -- Normal
There are no suspicious masses or calcifications to report; tissue looks healthy.

Category 2 -- Benign or Negative
Breasts are same size and shape and tissue looks normal. Any cysts, fibroadenomas, or other masses appear benign.

Category 3 -- Probably Benign
There are no suspicious lesions, masses, or calcifications to report, but follow-up to confirm that no cancer exists is recommended. This may be needed if your radiologist does not have your baseline or a previous mammogram for comparison.

Category 4 -- Possibly Malignant
There are some suspicious lesions, masses, or calcifications to report; a breast biopsy is recommended to check the suspicious area.

Category 5 -- Malignant
There are masses with an appearance of cancer. A biopsy is recommended to make an accurate diagnosis.

Category 6 -- Malignant Tissue - Tissue from a biopsy has been examined and found to be cancerous, and treatment such as surgery, chemotherapy, and/or radiation is required.

BIRADS Scores Table

CategoryDiagnosisNumber of Criteria
0IncompleteYour mammogram or ultrasound didn't give the radiologist enough information to make a clear diagnosis; follow-up imaging is necessary
1NegativeThere is nothing to comment on; routine screening recommended
2BenignA definite benign finding; routine screening recommended
3Probably BenignFindings that have a high probability of being benign (>98%); six-month short interval follow-up
4Suspicious AbnormalityNot characteristic of breast cancer, but reasonable probability of being malignant (3 to 94%); biopsy should be considered
5Highly Suspicious of MalignancyLesion that has a high probability of being malignant (>= 95%); take appropriate action
6Known Biopsy Proven MalignancyLesions known to be malignant that are being imaged prior to definitive treatment; assure that treatment is completed


Johns Hopkins Medicine. Breast Imaging, Reporting & Data System (BI-RADS). Accessed 02/28/16.

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