Women with BI-RADS 3 mammography results should undergo 6-month follow-up

Women who receive a BI-RADS 3 diagnosis during mammography screening should undergo a follow-up appointment at the six-month mark, according to the results of a large study published Tuesday.

The research, which included more than 43,000 women, found that slightly under 2% of individuals tagged with a “probably benign” finding were later diagnosed with cancer.

Additionally, the malignancy rates in BI-RADS 3 patients “substantially exceeded” those who were downgraded to category 1 or 2 at follow-up, which further establishes six-month follow-up surveillance, first author Wendie Berg, MD, PhD, wrote in Radiology. The findings also clear up some ongoing debate in the breast imaging community over whether probably benign follow-up exams could be pushed back to a year.

“The important thing about this paper is that these data come from a wide number of facilities across the United States, so it really brings to bear that, yes, this is the appropriate practice and yes, you still need to see these patients in six months,” Berg, a well-known breast cancer researcher at the University of Pittsburgh School of Medicine, added in a statement.

For their study, Berg and colleagues examined outcomes from six-, 12-, and 24-month follow-up of probably benign lesions spotted on screening mammography in the National Mammography Database. Berg noted that much of the contention over pushing BI-RADS 3 follow-up from six months to one year started before this large dataset was available.

In total, 43,628 women with no personal history of breast cancer underwent either biopsy or two-year follow-up. Each was recalled from screening at a subsequent exam at some point over a nearly 10-year period.

In addition to the 810 women diagnosed with cancer, about one-third had an early stage, noninvasive form of the disease (ductal carcinoma in situ). And 57.8% of cancers were found at or before the six-month follow-up exam.

“The majority of cancers were diagnosed at or right after the six-month follow-up, so it actually is important to get these patients back in that six-month time frame,” Berg added.