Breast density reporting in Aotearoa New Zealand: policy imperatives and research priorities.

Breast density influences both breast cancer risk and the sensitivity of mammographic screening. Several countries routinely notify women of their breast density in community-based screening programmes and provide guidance directly or through general practitioners. In contrast, BreastScreen Aotearoa (BSA) does not currently notify breast density to women, resulting in limited awareness and raising concerns relating to equitable care, patient autonomy in decision making, trust in health professionals and uncertainty regarding clinical pathways. Although the recent Health New Zealand - Te Whatu Ora technical review provides a comprehensive evidence summary and identifies areas for further investigation, policy progression has not occurred as anticipated. An implementation timeline, governance responsibility, communication planning and culturally responsive approach have not yet been specified. Although emerging evidence suggests that artificial intelligence may offer more consistent and reproducible breast density assessment than radiologists, planning for its integration has not been outlined. Research from the comparable settings suggests that misunderstanding, rather than notification itself, drives anxiety. This highlights the importance of communication design, health literacy considerations and primary care readiness. Ethical considerations around transparency and informed decision making remain relevant for screening equity. Addressing the implementation barriers is now crucial, and a coordinated and equity-driven approach is required to inform future policy on breast density notification.