Breast Cancer · May 30, 2021

How not to interpret BIRADS category on your mammography report

5 Minutes Read


BIRADS 0 – This category suggests your breasts are either too dense and radiologist is not clear of the findings. An abnormality can easily be missed in such cases, and hence the radiologist may suggest further investigations for example, a 3D mammogram, additional views, ultrasound examination or breast MRI. Or there may be a finding seen on mammogram which needs comparison with previous imaging/ reports.

What BIRADS 0 does not mean is that everything is normal and you need not do anything. In case you are not clear about the next step, discuss it with your radiologist. Do not shy away from getting additional imaging done if suggested.


BIRADS 1– This category suggests your breasts are normal on mammography. You should continue getting annual screening mammograms done, if you are above 40 years of age. However, if you have a symptom and either are not satisfied by the results, discuss it with the radiologist.

What BIRADS 1 does not mean is that you should stop getting annual mammograms done. Just because your consecutive mammograms are normal, does not mean these will always be normal in coming years also. Annual mammograms can pick up abnormalities earlier, much before these can become palpable. Early diagnosis can have a positive treatment outcome adding years to your life.


BIRADS 2 – Benign imaging findings. There are changes seen on your breasts which the radiologist is 100% sure are non cancerous. Breast cysts which are commonest cause of palpable breast lumps are categorized under this category. You should continue with annual screening mammogram. Always provide your previous images to the radiologist for comparison.

What BIRADS 2 does not mean is that there are chances of this being cancerous. Do not get tensed thinking about the outcome.


BIRADS 3– Probably Benign findings. The findings seen on your mammogram have > 98% chance of being benign. A short interval follow-up examination may be suggested for a period of upto 2 years to ascertain benign nature of these masses. Sometimes the radiologist may recommend a biopsy.

What BIRADS 3 does not mean is there is no need for further imaging or biopsy. These tests should be done as suggested by the radiologist to rule out malignancy which may be seen in < 2 % of cases.


BIRADS 4– Highly suspicious of malignancy. The findings seen on your mammogram are not clearly indicative of cancer but there are high chances of these being due to cancer. These may need further imaging. A biopsy is needed for characterization.


BIRADS 5– Highly suggestive of malignancy. The findings seen on your mammogram are most likely to be cancer. These may need further imaging. A biopsy is needed for characterization.

What BIRADS 4 or 5  does not mean is- in case your biopsy report is suggestive of benign findings. You may still need a repeat biopsy or an excisional (surgical) biopsy which may then suggest malignancy.

This information is for general guidance and reflects the opinions and experience of the author. It is not intended to replace specialist consultation or provide treatment advice for specific cases.