PURPOSE: Our study has three main aims: 1) to assess the distribution of Breast Imaging Reporting and Data System (BI-RADS) classifications in a cohort of Turkish women undergoing screening mammography, 2) to analyze the frequency and non-completion rates of recommended follow-up ultrasound (US) examinations, and 3) to examine the outcomes of completed follow-up US examinations. Our goal was to evaluate potential gaps in the current breast cancer screening process by analyzing BI-RADS classifications, follow-up completion rates, and outcomes of completed ultrasound examinations. PATIENTS AND METHODS: This retrospective study analyzed 1761 Turkish women who underwent screening mammography from 2020-2022 at the Istanbul Aydin University General Surgery Clinic, Istanbul, Turkey. We assessed the distribution of BI-RADS classifications, analyzed the frequency and non-completion rates of recommended follow-up US, and examined the outcomes of completed follow-up US examinations. Chi-square tests of independence and Spearman's rank correlation test were used to analyze the data. RESULTS: Our study revealed three key findings: 1) Over half of mammograms (55.9%) were classified as BI-RADS 0, requiring further imaging. 2) Nearly one-third of patients who recommended US examinations (31.91%) did not complete recommended follow-up ultrasound appointments. 3) Among those who completed follow-up ultrasonography, almost one-third (29.7%) were reclassified as BI-RADS 3 or higher. Notably, 2.3% (n=18) were classified as BI-RADS 4 or 5, suggesting findings suspicious for malignancy. CONCLUSION: Our findings highlight the crucial role of follow-up US in breast cancer screening. The high rate of initial BI-RADS 0 classifications using mammography, coupled with the significant non-completion rate for follow-up US examinations, particularly among older age groups, highlights potential gaps in the current screening process.