Yaaayyy! So, you have finally done your mammogram and it was not the horror show you thought it would have been. What’s next?

Your images will now be interpreted by the specialist, the radiologist and a report will be done. That report will describe the breast tissue type and other findings using a standardised system for reporting images of the breasts, BI-RADS.

Breast tissue density

Breast tissue density describes the ratio of fibrous and glandular tissue present against fatty tissues. Knowing the density is important as denser breasts can hide suspicious findings. There are four (4) ways to describe breasts:

1.Fatty: Fatty breasts account for 10 per cent of all tissue types and appear as mostly black or grey on mammograms with little areas of fibroglandular tissue (which appears as white).

2. Scattered fibroglandular: This breast has more areas of white (fibroglandular) that are mixed with fat and scattered throughout the breasts. This breast type accounts for 40 per cent of all breast types.

3. Heterogeneously dense: Heterogeneously dense breasts make up 40 per cent of all breast types. Mammograms with this density type will have large areas of white (fibroglandular tissue) scattered throughout the breast.

4.Dense: Dense breasts on mammography appear as mostly white which limits the sensitivity of the test, that is, making it hard to tell whether a mass is present. This tissue type accounts for 10 per cent of all tissue types.

BI-RADS

The American College of Radiology (ACR) developed a tool to be used in reporting breast images acquired through ultrasound, MRI or mammogram. This tool, Breast Imaging- Reporting And Data System (BI-RADS), assesses the risk of breast cancer as well as it is a quality assurance tool that has become standard and will be found on your report. It is divided into the following categories:

• BI-RADS 0: Incomplete

The radiologist may have seen a possible abnormality however it was not clear and as such, more images may be needed. These may include: special mammography views, magnified views, spot compressions (applying greater compression to a specific area of interest on mammography), or an ultrasound. It may also mean that the patient has a previous mammogram which is needed for comparison over time.

•BI-RADS 1: NegativeThis means that nothing bad was seen. There is no significant abnormality, and the breasts look normal in size with no suspicious calcifications, lumps (masses) or distorted structures.

•BI-RADS 2: Benign (non-cancerous) finding

The radiologist sees an abnormality that is not cancerous — be it a calcification, calcified fibroadenoma (benign breast tumour) or lymph node and is mentioning its presence. This will ensure that another doctor looking at the images or the report will not misinterpret the finding as suspicious.

•BI-RADS 3: Probably benign

With this classification, the radiologist sees where there is a less than two per cent chance of the findings being cancer and not expected to change over time. However, since that possibility still exists, until the finding is deemed stable, they will likely ask for a follow-up with repeat imaging in six months and regularly after. This helps in early diagnosis and to avoid unnecessary biopsies (removing of tissue samples).

• BI-RADS 4: Suspicious for malignancy

The radiologist sees an area of suspicion and is not sure whether it is cancerous or not and recommends a biopsy. There are three suspicion levels:

4A: Low possibility of being cancer (2 per cent – 10 per cent)

4B: Moderate possibility of being cancer (11 per cent – 50 per cent)

4C: High possibility of being cancer (51 per cent -95 per cent), still not as high as Category 5

• BI-RADS 5: High suspicion for malignancy

The findings look like cancer and have a very high possibility (at least 95 per cent) of being cancer. A biopsy is very strongly recommended.

• BI-RADS 6: Known biopsy, proven malignancy

This category is only used for findings that are known to be cancer by a previously done biopsy and may be used in this way to see how well the cancer is responding to treatments.

It is very important that whether you were self-referred or not that you take your results to your doctor to be discussed. There is no substitute for this relationship.

Kamala Anderson is a local and American board certified cardiac CT technologist, mammographer and interventional radiology technologist with a medical marketing business. She may be contacted via email at andersonkamala@yahoo.com or Instagram @radkam876