Beyond the Results Letter: Understanding Your Mammogram Report

You open the envelope—or more likely these days, the patient portal notification on your phone—and there it is: your mammogram results. Maybe it says “BI-RADS Category 0” or mentions something about “dense breast tissue” or “architectural distortion.” Your heart might skip a beat. You scan the page looking for words you recognize, but the medical terminology feels like it’s written in a different language entirely.

Here’s what nobody tells you: mammogram results aren’t designed to be intentionally confusing, but they are written primarily for your doctor. The good news? Once you understand the basic framework radiologists use to categorize findings, those results become much less mysterious—and you become a much more informed partner in your own breast health.

The BI-RADS System: Your Results Decoder Ring

Every mammogram in the United States is categorized using something called the BI-RADS system (Breast Imaging Reporting and Data System), developed by the American College of Radiology. Think of it as a standardized language that ensures radiologists across the country are speaking the same way about what they see. Our board-certified breast imaging radiologists use this system, along with guidelines from the American College of Radiology and Society of Breast Imaging, to provide you with clear, accurate results that guide your next steps. Here’s what each category actually means:

Category 0: Incomplete – Additional Imaging Needed

This is the category that causes the most anxiety, but it shouldn’t. Category 0 simply means your radiologist needs more information before they can give you a complete assessment. Maybe something was obscured by overlapping breast tissue, or they want a closer look at one specific area. About 10-15% of screening mammograms result in a callback for additional views—and the vast majority of these callbacks reveal nothing concerning.

If you receive a Category 0 result, you’ll be contacted to schedule additional imaging, which might include diagnostic mammogram views with our 3D mammography technology, ultrasound, or occasionally MRI. This isn’t a diagnosis; it’s just the next step in getting you complete, accurate results. We prioritize callbacks and work to accommodate you as quickly as possible.

Category 1: Negative

This is the “all clear” result. Your radiologist found no masses, architectural distortions, or suspicious calcifications. Continue with your regular screening schedule—typically annual mammograms for most women over 40, though your personal schedule may vary based on your risk factors.

Category 2: Benign Findings

Category 2 means your radiologist found something, but they’re confident it’s not cancer. This might include benign calcifications, lymph nodes, implants, or changes from prior breast procedures. These findings are documented but require no action beyond your regular screening schedule.

The following categories 3, 4, and 5, typically apply to diagnostic imaging, not screening mammograms.

Category 3: Probably Benign

This category falls into a gray zone. Your radiologist sees something that’s most likely benign (statistically, less than 2% of Category 3 findings turn out to be cancer), but they want to monitor it with a short-term follow-up mammogram—usually in six months. This allows them to confirm that the finding is stable and truly benign without recommending an immediate biopsy.

Category 4: Suspicious – Biopsy Should Be Considered

Category 4 findings don’t look typically benign, and a biopsy is recommended to determine whether the tissue is cancerous. This category has subcategories (4A, 4B, 4C) that reflect increasing levels of suspicion, ranging from low (4A, about 2-10% likelihood of cancer) to moderate (4B, 10-50% likelihood) to high (4C, 50-95% likelihood).

A Category 4 result understandably causes significant anxiety, but remember: even at the highest subcategory, there’s still a possibility the finding is benign. The biopsy is how we find out for certain. We understand the stress this creates, which is why we offer same-day stereotactic biopsies on our Affirm® Upright Stereotactic Biopsy System—meaning your diagnostic workup and biopsy can often be completed in a single visit, and results are provided as quickly as possible.

Category 5: Highly Suggestive of Malignancy

These findings have a 95% or higher likelihood of cancer, and biopsy is urgently recommended. While this is the result no one wants, early detection—which is exactly what screening mammography provides—dramatically improves treatment outcomes.

Category 6: Known Biopsy-Proven Malignancy

This category is used for imaging performed after a cancer diagnosis, typically to track treatment response or surgical planning.

What This Means for You: From Categories to Action

Understanding your BI-RADS category is just the first step. Here’s how to translate that category into your next actions:

If you receive a Category 0 result, rest assured you won’t be navigating this alone. Our staff will reach out to you directly—typically before the written report even appears in your portal—to schedule any additional views and address your immediate questions. If you’d like to speak with us sooner or need further support, please don’t hesitate to call us at 952-915-4320.

For Categories 1 and 2, simply note your next screening date in your calendar.

One more important consideration across all categories: If you have dense breast tissue (mentioned separately in your results), talk to our team about whether supplemental screening with breast ultrasound might be appropriate for you. We offer this service as supplemental screening for women with dense breasts to provide more comprehensive imaging.

Category 3 requires commitment to that six-month follow-up. Put it in your calendar now and set multiple reminders. These short-interval follow-ups are crucial for confirming that the finding is stable.

Categories 4 and 5 require moving forward with a biopsy. We can often perform your biopsy the same day as your diagnostic imaging, reducing the anxiety of waiting and the need for multiple appointments. Our upright stereotactic biopsy system is designed for your comfort, with specialized positioning that makes the procedure easier for both you and our dedicated breast imaging radiologists.

Here are the questions you should feel empowered to ask:

• What specifically did you see that led to this category?
• What are my options for additional imaging or biopsy?
• What is the timeline for my next steps?
• If I have dense breasts, what supplemental screening do you recommend?
• Based on my results and personal risk factors, should I consider genetic counseling?

Your Partner in Breast Health

As an American College of Radiology (ACR) designated Breast Center of Excellence, we meet the highest standards in breast imaging quality and safety. Our practice exceeds the minimum Mammography Quality Standards Act (MQSA) requirements through cooperative quality assurance studies with our affiliated institutions, and our data consistently surpasses national ACR benchmarks.

But being a center of excellence means more than just meeting technical standards—it means providing compassionate care throughout your entire breast health journey. Our team of board-certified breast imaging radiologists and knowledgeable technologists certified in mammography and ultrasound is here to provide guidance and support, not just during your appointment, but whenever questions arise about your results.

Being Your Own Best Advocate

One of the most important things you can do for your breast health is keep your own records. Through our patient portal, you have 24/7 access to your imaging records and reports. Each year, review your actual imaging report (not just the summary letter). Note your BI-RADS category, any findings mentioned, and your breast density category. This personal archive helps you track changes over time and serves as a valuable reference for your ongoing breast health.

If you’re called back for additional imaging, remember this: callbacks are common, and most reveal nothing concerning. The 10-15% callback rate means that if you’re screening regularly for decades, you’ll likely experience a callback at some point. It doesn’t mean that something was missed previously—breast tissue changes over time and overlapping tissue can obscure areas that need a second look.

The Bottom Line

Your mammogram results aren’t meant to be mysterious—they’re a roadmap for your breast health, written in a standardized language that ensures consistency and quality across the entire field of radiology. When you understand what those categories mean and what actions they require, you transform from a passive recipient of healthcare to an active, informed partner in your care.

We’ve designed our entire practice around making that partnership as supportive and stress-free as possible. From our warm, inviting imaging suites to our same-day biopsy capabilities, from our experienced team to our 24/7 online portal access—every aspect of our care is focused on you.

This February, commit to understanding your results, asking questions, and taking the appropriate next steps. Because when it comes to breast health, knowledge truly is power—but only if you understand what you’re reading.

Questions about your mammogram results? We’re here to help you understand what they mean and what comes next. Contact CRL Women’s Imaging:

952-915-4320 Contact Us Request an Appointment

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About CRL Women’s Imaging

CRL Women’s Imaging is a leader in outpatient imaging and designated a Breast Center of Excellence by the American College of Radiology (ACR). Our team of board-certified breast imagers and certified technologists in mammography and ultrasound are committed to providing high-quality, compassionate care that women can trust.