April 29, 2020

✪ A phased approach to implementing the Breast Imaging Reporting and Data System (BI‐RADS) in low‐income and middle‐income countries


Diana L. Lam, Pegah Entezari, Catherine Duggan, Zeridah Muyinda, Andres Vasquez, Jorge Huayanay, Benjamin O. Anderson, & John R. Scheel

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2020

Read the full text in the open access journal Cancer



Successful breast cancer detection programs rely on standardized reporting and interpreting systems, such as the Breast Imaging Reporting and Data System (BI‐RADS), to improve system performance. In low‐income and middle‐income countries, evolving diagnostic programs have insufficient resources to either fully implement BI‐RADS or to periodically evaluate the program's performance, which is a necessary component of BI‐RADS. This leads to inconsistent breast ultrasound interpretation and a failure to improve performance.


The authors applied the Breast Health Global Initiative's phased implementation strategy to implement diagnostic ultrasound and BI‐RADS within the context of a limited‐resource setting.


The authors recommended starting with triage ultrasound to distinguish suspicious masses from normal breast tissue and benign masses such as cysts because the majority of health workers performing ultrasounds at this level have minimal breast imaging experience. Transitioning to full diagnostic ultrasound with condensed or full BI‐RADS should occur after performance and quality metrics have been met.


Transitioning through these phases across facilities likely will occur at different times, particularly in rural versus urban settings.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**