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Mammogram Results: Breast Imaging Reporting and Database System (BI-RADS)

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Radiologists in the United States and some other countries use the Breast Imaging Reporting and Database System, or BI-RADS, to report the findings of mammograms. The American College of Radiology (ACR) created this system to provide one way for all radiologists to categorize their findings and create a follow-up action plan. Talk to your doctor about what category your result falls into and what follow-up plan he or she recommends.

Breast Imaging Reporting and Database System (BI-RADS)

Category Assessment Follow-up
0 Need additional imaging evaluation: means that more studies are necessary to gather more information. Additional imaging needed before a category can be assigned.
1 Negative: means that there is no significant or noticeable abnormality to report. Continue annual screening mammography (for women over age 40).
2 Benign (noncancerous) finding: means that there has been a finding, such as benign calcifications or fibroadenoma, which is not cancerous. Continue annual screening mammography (for women over age 40).
3 Probably benign: means that there is a finding that is most likely benign, but should be followed in a shorter period of time to see if the area of concern changes. Receive a 6-month follow-up mammogram.
4 Suspicious abnormality: means that there are suspicious findings that could turn out to be cancer. May require biopsy.
5 Highly suggestive of malignancy (cancer): means that there are findings that look like and probably are cancer. Requires biopsy.
6 Known biopsy-proven malignancy (cancer): means that any findings on the mammogram have already proven to be cancer through a biopsy. Biopsy confirms presence of cancer before treatment begins.

Mammogram reports also include an assessment of your breasts’ density. Dense breasts have less fatty tissue and more non-fatty tissue compared to breasts that aren’t dense. Dense breasts:

  • can be twice as likely to develop cancer as nondense breasts
  • can make it harder for mammograms to detect breast cancer; breast cancers (which look white like breast gland tissue) are easier to see on a mammogram when they’re surrounded by fatty tissue (which looks dark)

BI-RADS classifies breast density into four groups:

  • Mostly fatty: The breasts are made up of mostly fat and contain little fibrous and glandular tissue. This means the mammogram would likely show anything that was abnormal.
  • Scattered density: The breasts have quite a bit of fat, but there are a few areas of fibrous and glandular tissue.
  • Consistent density: The breasts have many areas of fibrous and glandular tissue that are evenly distributed through the breasts. This can make it hard to see small masses in the breast.
  • Extremely dense: The breasts have a lot of fibrous and glandular tissue. This may make it hard to see a cancer on a mammogram because the cancer can blend in with the normal tissue.

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