Until the introduction of the BI-RADS system in the breast cancer screening program, the screening radiologist was not able to indicate his orher degree of suspicion for malignancy when referring a woman to hospital. This meant that all women were referred to the mamma-care team and waiting times increased for performing follow-up investigations in hospital. Using the BI-RADS system, we designed a randomized controlled trial to investigate an alternative referral strategy where women with a low suspicion of malignancy (BI-RADS 0) were referred to the radiologist rather than the surgeon and had additional imaging and/or ultrasound within two working days. The results of the trial, funded by ZonMw (Broeders) and published in 2014 (Can J Public Health, 2014) showed that this was a cost-effective strategy. Discussions were initiated with all relevant stakeholders, which finally led to the introduction of this new referral strategy in July 2017. This change has considerable impact on the women referred from screening, since about 50 to 60% of these women are BI-RADS 0. In about half of these cases, additional imaging performed by the radiologist is sufficient to decide that the woman will not require any further follow-up and can be re-invited for screening in two years.