Is BI RADS 5 Always Cancer?

December 26, 2024

Medically reviewed by Dr. Doug Blayney on December 26, 2024.

Introduction

When you hear about BI-RADS 5, it can feel overwhelming. As someone who has faced the uncertainties of breast cancer, I understand how much weight these medical terms can carry and how confusing they can be – especially in the beginning when you’re dropped into Cancerland without a map. Let's break it down together so you can feel informed and empowered.

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What is BI-RADS?

The Breast Imaging Reporting and Data System (BI-RADS) is a tool radiologists use to classify findings from breast imaging like mammograms, ultrasounds, or MRIs. This system helps standardize reporting and guides doctors on what steps to take next. BI-RADS categories range from 0 to 6, each representing different levels of concern or diagnostic clarity.

What Does the BI-RADS Scoring System Tell Us?

BI-RADS scores provide an estimate of the likelihood that a finding might be cancerous:

BI-RADS 0: Incomplete. Additional imaging or information is needed. (This is used when the mammogram is of poor quality, probably because of problems with the radiology machine or the technique used to obtain and process the films. This is nothing for the pateint to be alarmed about, but the exam should be rescheduled)
BI-RADS 1: Negative. Nothing abnormal was detected.
BI-RADS 2: Benign. Findings are definitely not cancer. (This number is often assigned by the radiologist to acknowledge that they have seen signs of a previous biopsy or resection. Thus, the exam is not absolutely normal, but there are no new findings of concern)
BI-RADS 3: Probably benign. A small chance of cancer exists; follow-up imaging is usually recommended. (This number is assigned when a shorter follow up – that is more often than once yearly or every other year to investigate the findings. If there is a high suspicion of cancer, then the number “4” is assigned)
BI-RADS 4: Suspicious. This category is subdivided into 4A, 4B, and 4C, indicating increasing levels of suspicion.
BI-RADS 5: Highly suspicious for malignancy. There's a greater than 95% chance that the finding is cancer. (This number is a flag that a biopsy or other study should be carried out soon)
BI-RADS 6: Known biopsy-proven malignancy.

Focusing on BI-RADS 5, it’s essential to understand that while it signals a high likelihood of cancer, it’s not a definitive diagnosis.

How Are Mammograms Scored?

Radiologists assess mammograms by looking for specific signs:

Masses: Shapes, borders, and densities of lumps in the breast.
Breast Density: Dense breast tissue can make it harder to spot abnormalities.
Calcifications: Tiny calcium deposits that may indicate cancer or other conditions.
Asymmetry: Uneven tissue distribution between breasts.
Tissue Lesions: Any unusual growths or abnormalities.

These factors help radiologists determine the BI-RADS category and recommend next steps.

Understanding BI-RADS 5

A BI-RADS 5 classification means the radiologist sees characteristics that are strongly associated with cancer, such as:

Irregularly shaped masses with uneven borders.
Spiculations (spiky or star-like edges).
Suspicious calcifications.

These findings are why BI-RADS 5 is linked with a high suspicion of malignancy. But it’s crucial to remember that even this category is not a guarantee of cancer.

Does BI-RADS 5 Always Indicate Cancer?

The term “high suspicion” is important here. While most BI-RADS 5 findings turn out to be cancer, exceptions exist:

Benign Conditions: Some non-cancerous conditions can mimic cancer, such as fat necrosis (scar tissue from injury) or radial scars (complex, star-shaped growths).
False Positives: Mistakes in imaging interpretation or overlapping benign features can lead to a BI-RADS 5 classification.

This is why biopsy confirmation is always necessary for BI-RADS 5 findings.

Diagnostic Pathway for BI-RADS 5

If you or a loved one receives a BI-RADS 5 result, the next steps are critical:

Biopsy: The most definitive way to determine whether a lesion is malignant. Types include:

Core needle biopsy: Removes a small tissue sample.
Fine needle aspiration: Extracts cells with a thin needle.
Excisional biopsy: Removes the entire suspicious area.

Pathology Evaluation: A pathologist examines the sample under a microscope to confirm the diagnosis.
Additional Imaging: Tests like MRI or PET scans may provide further insights, especially for complex cases.
Second Opinions: If the findings are borderline or unclear, seeking another expert’s view can be reassuring.

Emotional and Psychological Implications

Hearing “BI-RADS 5” can be terrifying. The uncertainty of waiting for biopsy results might cause anxiety, fear, or even sleepless nights. Here are a few tips to cope during this time:

Lean on Your Support System: Family, friends, or support groups can provide emotional and practical help.
Educate Yourself: Understanding your situation can reduce fear of the unknown.
Practice Self-Care: Whether it’s journaling, meditation, or a relaxing walk, find what soothes you.

For healthcare providers, clear and compassionate communication can make a world of difference. Patients need honest but empathetic explanations to help them process the information.

Prognosis and Treatment Considerations

If a biopsy confirms malignancy, treatment depends on the cancer’s stage and characteristics:

Early-Stage Cancer: Often treated with surgery, radiation, or hormone therapy.
Advanced Cancer: May require chemotherapy, targeted therapies, or a combination of treatments.

For benign findings, follow-up care might involve monitoring or treating underlying conditions like infections or benign tumors.

Join a community of people who “get it”

The Manta Cares team is composed of cancer survivors, caregivers, oncologists and nurses - so we truly understand the challenges that come with a cancer diagnosis because we’ve been there. We are here to walk with you as you go through your own cancer experience. Please don’t hesitate to reach out with any questions. We have even developed Your Cancer GPS™, a platform with disease-specific step-by-step maps to show you all the paths you might face during your cancer experience, future treatment options and connect you with relevant support and resources. Sign up for access to the Your Cancer GPS™ platform here.

Be sure to subscribe to our newsletter and check out our free resources like our Chemotherapy Checklist for Caregivers, Financial Checklist for Cancer Treatment and more. We also put out a bi-weekly podcast called the Patient from Hell to educate, empower and hopefully inspire you as you go through this crappy experience. You can listen on Spotify, Apple Podcasts, YouTube or anywhere you listen to podcasts. Dealing with cancer as a patient or caregiver can feel really lonely. Just know that you are not alone in this experience.

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Conclusion

A BI-RADS 5 result is serious and warrants immediate follow-up, but it’s not an automatic cancer diagnosis. Understanding this category and its implications can help you take the right steps toward clarity and peace of mind. Remember, early and accurate diagnosis is key to the best possible outcomes.

FAQs on BI RADS 5

Q: What percentage of BI-RADS 5 results are benign?

Ans - While rare, approximately 3-5% of BI-RADS 5 findings turn out to be benign after a biopsy.

Q: Can BI-RADS 5 findings ever resolve without treatment?

Ans - No, BI-RADS 5 findings require biopsy confirmation and appropriate treatment based on the results.

Q: How long does it take to get biopsy results for BI-RADS 5?

Ans - Results typically come back within a few days to a week.

Q: What are the differences between BI-RADS categories 4 and 5?

Ans - BI-RADS 4 indicates suspicious findings with a lower cancer probability, while BI-RADS 5 signifies a high likelihood of malignancy.

Q: Why is BI-RADS 5 associated with such high suspicion for cancer?

Ans - The imaging features of BI-RADS 5 findings, like irregular margins and spiculations, strongly correlate with cancer.

Q: What happens after a BI-RADS 5 finding?

Ans - The next steps usually include a biopsy, pathology evaluation, and, if confirmed, planning for treatment.

Q: How is a biopsy performed for BI-RADS 5 lesions?

Ans - Biopsies involve using needles or surgical techniques to extract tissue or cells for analysis.

Q: What imaging techniques are used to confirm or rule out cancer in BI-RADS 5 cases?

Ans - MRI, PET scans, and sometimes additional mammograms or ultrasounds may be used.

Q: What are the most common reasons for false-positive BI-RADS 5 results?

Ans - Imaging artifacts, interpretation errors, or benign conditions like fat necrosis or radial scars can lead to false positives.

Disclaimer: All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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