When you have had an ultrasound, a mammogram, or an MRI of your breast, you may have seen something called BI-RADS on the report. Or your doctor may have told you about it. So, for many people, this is a bit unfamiliar, so they may be a little confused and ask, "What is this BI-RADS?" Don't worry, let's talk about it simply and clearly.
What is `BI-RADS`? Why is it used?
Simply put, `BI-RADS` is an abbreviation for the English words "Breast Imaging-Reporting and Data System" . In Sinhala, it means something like "Breast Imaging Reporting and Data System". This is a very important system. Because, not only in Sri Lanka, but all over the world, radiologists (that is, doctors who perform scans like `(Ultrasound)`, `(Mammogram)` and analyze their results) use this system to record information in your breast examination reports.
Imagine, you had a mammogram done at one place, and someone else did it at another place. How confusing would it be if everyone didn't talk about those results in the same way, in the same language? This BI-RADS system has been introduced as a solution to that problem.
There were two main reasons for introducing this system:
1. Standardize reporting: Establish a standard way for radiologists to report findings from breast exams. This will ensure that everyone, no matter where they are in the world, understands the information in the same way. This will greatly reduce the risk of misunderstandings.
2. Make breast cancer risk easy to understand: Presenting your risk of developing breast cancer in a way that is easy for you and the other doctors who treat you to understand.
You may not see the `(BI-RADS)` symbol directly in your electronic medical record (`(Electronic Medical Record)`). However, it is definitely there in your doctor's record. You can ask your doctor what your `(BI-RADS)` symbol is and what it means. This is your right.
What are the `BI-RADS` categories? What do your scores say?
BI-RADS categories are usually numbered from zero (0) to six (6). This is the same system used regardless of which breast exam you have (Mammogram, Ultrasound, MRI). However, depending on the BI-RADS score you receive, your follow-up care may vary. For example, if you have a Mammogram and receive a BI-RADS score, your doctor may recommend another Mammogram, Ultrasound, MRI, or Biopsy (a small sample of tissue is removed for testing).
Let's see what each of these categories simply says:
- `BI-RADS 0`: Incomplete
- This means that the test cannot reach a complete conclusion and that more information is needed. It may be necessary to compare previous `(Mammogram)` reports, or you may be asked to do more specific `(Mammogram)` views or `(Ultrasound)` tests. This does not mean that there is something wrong, it just means that there is not enough information.
- `BI-RADS 1`: Negative
- This is the best result! This means that no suspicious lumps or changes were found in your breasts. Everything is normal. It is recommended that you have regular breast exams (`(Routine screening)`) at the scheduled time.
- `BI-RADS 2`: Benign Finding
- This is also a good result. This means that even if something is found in the breast (for example, a fluid-filled cyst, a non-cancerous lump such as a fibroadenoma), it is not cancer and is not benign . There is nothing to worry about even if there are such things. In this case, it is also recommended to check the breasts at the usual time.
- `BI-RADS 3`: Probably Benign, Short-Interval Follow-Up Suggested
- This means that the finding is 98% unlikely to be cancer, meaning it is probably benign . However, to be 100% sure, it is recommended to have another test (Mammogram or Ultrasound) in about 6 months. This is to see if the finding changes or gets bigger over time. Most of the time, these things stay the same or go away. So don't worry.
- `BI-RADS 4`: Suspicious Abnormality, Biopsy Should Be Considered
- This is the sign that makes many people nervous. This means that there is a chance that what was found during the test is cancerous, so it is suspicious . But `BI-RADS 4` does not mean that there is cancer. The risk of cancer can range from 2% to 95%. Therefore, the doctor may recommend a `(Biopsy)`, which means taking a small piece of tissue and examining it, to find out exactly what this finding is.
- The `BI-RADS 4` category is further divided into three subgroups (4A, 4B, 4C), indicating a low, moderate, and slightly increased risk of cancer. Your doctor will tell you more about this. The most important thing is to not be afraid of the repercussions of having a `(Biopsy)`, but to do it and find out for sure.
- `BI-RADS 5`: Highly Suggestive of Malignancy, Biopsy Is Strongly Recommended
- This means that the probability of what was found being cancer (`(Malignancy)`) is very high (more than 95%) . Therefore, it is definitely recommended to do a `(Biopsy)` to confirm this. It is sad to receive this result, but it is important to get an accurate diagnosis and start treatment as soon as possible.
- `BI-RADS 6`: Known Biopsy-Proven Malignancy
- This category is used for tests that you have already had a biopsy to confirm that you have breast cancer and are undergoing treatment for it . For example, this symbol is used in tests that are done before surgery to see how large the cancer is and how it will respond to treatment.
The BI-RADS system was first introduced in 1993 by the American College of Radiology (ACR) to standardize mammography reports. It was later adapted for MRI and ultrasound. This is why radiologists around the world use the same terminology when talking about breast exams.
What are the advantages of the `BI-RADS` system?
There are several main advantages to this method:
- Standardization: As we mentioned earlier, radiologists all report findings in the same way, using the same words. This consistency improves the quality of reports and reduces misunderstandings. Even if you go from one doctor to another, the report is easy to understand.
- Risk assessment: The `(BI-RADS)` method gives a rough estimate of your risk of developing breast cancer. This helps you plan how soon (`(Urgency)`) the next tests need to be done.
- Efficiency: By categorizing test results in this way, radiologists don't have to explain their findings in different ways each time. This saves time and makes work more efficient.
Imagine, if your report says "BI-RADS 2", you, your family doctor , and your oncologist ( if necessary ) all suddenly understand what it means. That's the biggest convenience of this.
Are there any drawbacks to the `BI-RADS` system?
Although this is a valuable method, it has some limitations and drawbacks:
- Subjectivity: There is some room for the radiologist's personal judgment and experience when determining a category based on what is found on a scan. If two people look at the same scan, there may be very little difference.
- False results: Although very rare, false positives (meaning cancer is not present) or false negatives (meaning cancer is missed when it is present) can occur. If this happens, it can cause unnecessary anxiety or delay the diagnosis of cancer. However, remember, these are very rare.
- Unspecific: Although this method of grouping test results describes the suspicious finding, additional details about the suspicious finding (such as its size, shape, location) are not provided by the ``(BI-RADS)`` label alone. These details are listed separately in the report.
Can `BI-RADS` accurately tell if there is cancer? Does `BI-RADS 4` mean cancer?
This is also a problem for many people. The ``BI-RADS'' system does not classify a cancer (``Classification'') or tell the stage of the cancer (``Staging''). The only exception is the ``BI-RADS 6'' category. Because it means that the presence of cancer has already been confirmed by a ``Biopsy''.
The other ``BI-RADS'' categories (especially 3, 4, and 5) only indicate the likelihood of cancer . For example, ``BI-RADS 3'' means that the finding is not suspicious, but that you should be re-examined in 6-12 months.
Now the most important question: Does `BI-RADS 4` mean cancer?
No. `BI-RADS 4` does not mean that you have cancer. It means that there is something unusual or suspicious in your test results, so a `(Biopsy)` is recommended to find out exactly what it is. As we have said before, the risk of developing breast cancer in the `BI-RADS 4` category can vary from 2% to 95%. This means that when a `(Biopsy)` is done, it is confirmed that it is not cancer in most people. Therefore, do not be discouraged or panic when you see `BI-RADS 4`.
It's normal to feel confused and have a lot of questions when you see an abnormal test result. Especially when it's hard to understand what's in the test report. That's where the ``(BI-RADS)`` system comes in. It has brought a standard to the words and phrases that appear on your breast exam report. This gives you a clear understanding of what the radiologist thinks about your test results.
The most important thing we need to learn from this (Take-Home Message)
Okay, so, from what we've talked about, these are the most important things you need to remember:
- `(BI-RADS)` is a method for presenting the results of breast examination reports (`(Mammogram)`, `(Ultrasound)`, `(MRI)`) in a standardized manner.
- That will give you a rough idea of your risk of developing cancer.
- `(BI-RADS)` has scores from 0 to 6. Not every score means that cancer is present.
- `BI-RADS 1` and `2` are good results, nothing to worry about.
- `BI-RADS 0` means more information is needed.
- ``BI-RADS 3`` means that it is probably good, but you need to check again in a while.
- `BI-RADS 4` or `5` means that it is suspicious, so a `(Biopsy)` should be done. `BI-RADS 4` does not necessarily mean that it is cancer.
- `BI-RADS 6` is a sign used for someone who already knows they have cancer.
The most important thing is to talk openly with your doctor about the ``BI-RADS'' sign and what it means for your condition, no matter what breast exam you have. They can answer any questions or concerns you may have.
It's normal to feel anxious and nervous about any test results you receive. However, knowing the right information and following your doctor's advice will help you make the best decisions about your health.
` Breast cancer, BI-RADS, mammogram, ultrasound, MRI, breast scan, cancer risk
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