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Breast cancer screening should be a regular part of preventative care for women over the age of 45, according to the American Cancer Society. Radiologists from around the world regularly share mammograms on the Figure 1 platform, and they will often take the time to teach medical students and other healthcare professionals about what they’re looking for and how to interpret the scans.

Radiologists initially interpret the imaging using the BI-RADS (Breast Imaging Reporting and Data System) classification, and discussion of the mammography cases shared on Figure 1 will often center on this system. BI-RADS is a lexicon established by the American College of Radiology to standardize the reporting of breast imaging and improve communication with referring physicians.

In brief, the BI-RADS classification system is as follows:
0 - Incomplete
1 - Negative
2 - Benign
3 - Probably Benign
4 - Suspicious
4A- Low Suspicion of Malignancy
4B- Moderate Suspicion of Malignancy
4C- High Suspicion of Malignancy
5 - Highly Suggestive of Malignancy
6 - Known Biopsy - Proven Malignancy
The system can be seen in practice in this case, where an internal medicine resident asked:

“What do you think? BI-RADS 4C or 5? I recommend biopsy eco-guide. 55-year-old woman, previous mammogram 4 years was normal.”

To which a radiologist responded,

“Any spot compression images? Looks a little worse on the mammo than the ultrasound, although definitely a BI-RADS 4 lesion at the least.”

If a screening mammogram offers cause for concern, the next step will generally involve more imaging. One of the top radiologists on Figure 1 used this teaching case to impart this valuable lesson on reading any screening mammogram:

“As noted by a few users, the next step on a screening mammo would ALWAYS be additional imaging. Never go straight to biopsy. We ultrasounded this mass, which is a cyst (and soft on elastography on 2nd image). It was asymptomatic and therefore left alone, and has been stable for many years now.

Teaching points:

  1. Not all masses are cancer
  2. Simple cysts are benign and need no intervention
  3. Never, ever, ever, ever go straight to a procedure (BI-RADS 4 or 5) from a screening mammogram.
  4. Don’t let FHX [family history] fool you.”

To view, discuss, and share medical images with radiologists, oncologists, and other specialists, healthcare professionals are encouraged to join Figure 1. It’s free and available on iOS, Android, and the web.