Grace Fotheringhame, Master of Health Psychology Student 08.06.26

Breasts. Boobs. Tits.

Whatever word you use, they are familiar to us all. Yet so much of the conversation around them is limited to appearance, sexuality, or reproduction. We talk about bras, cup sizes, cleavage, and breastfeeding, but what about breast health? What about breast cancer? And what about the information women are still not being told about their own bodies?

For many illnesses and diseases, we may know the name or understand the basic concept, but it's often not until someone we know, care about, or love is affected that it suddenly feels real. For me, I grew up waiting for my boobs to grow during high school, comparing cup sizes with my friends and celebrating every tiny increase like it was a major life achievement. Breast cancer felt distant, like something that happened to other people.

That changed when one of my mum's dearest friends was diagnosed with breast cancer. Suddenly, it was no longer just a word. It became something heavy, emotional, and frightening that stayed present in the lives of people around me for many years. Watching someone you care about navigate treatment, uncertainty, fear, and strength changes the way you see things forever.

So why am I writing this article? I am currently completing my Master of Health Psychology at the University of Auckland, and this year I am conducting my thesis research. From the beginning, I knew I wanted my research to focus on women's health. I knew I was not going to solve all the world's problems, but I still wanted to contribute to something meaningful... something that could raise awareness, spark conversations, and help women feel more informed and supported. I was also drawn to cancer research because it is a disease that has affected those close to me. I have watched family members fight cancer, fight for treatment, fight for information, and fight for more time with the people they love.

After many conversations with my incredible supervisor, we decided breast cancer would be an important and meaningful area to focus on, particularly because there are still major gaps in awareness, communication, and support services here in Aotearoa New Zealand.

I am sure you are familiar with breast cancer, but here are a few statistics to help you gauge the effects. Annually, approximately 2.3 million women are diagnosed with breast cancer around the world, and around 670,000 women die from it. In Aotearoa New Zealand, approximately 10 women are diagnosed with breast cancer each day, and more than 650 people die from breast cancer each year. There are also significant health inequities surrounding diagnosis and treatment, with Māori women 33% more likely, and Pasifika women 52% more likely, to die from breast cancer than other women. Additionally, over 30% of women eligible for free breast screening in Aotearoa are not taking part. These numbers highlight the scale of the issue but also raise questions about how well women are supported in understanding cancer-related risk information, such as breast density.

It wasn't until a conversation with my supervisor last year, when she mentioned dense breasts, that I realised how little I understood about breast health. I sat there very confused (trust me, I was shuffling through my brain trying to find any academic answer I could throw together, but I was honestly stumped). The first things that popped into my head were: hmmm, okay, dense breasts… mine feel quite firm, so do I have dense breasts? Oh no, is that a good thing or a bad thing? Why have I never heard of this before? Well, actually, it was none of the above.

Now I want you to ask yourself: what are dense breasts? If you do not know, you are definitely not alone. International research shows that most women have very low awareness and understanding of breast density, even though breast density is one of the most significant and common independent risk factors for breast cancer.

Breasts are composed of two main types of tissue: fatty tissue and fibroglandular tissue. Dense breasts contain more fibroglandular tissue, while less dense breasts contain more fatty tissue, and this proportion varies for everyone. You cannot tell by touching them, looking at them, or judging their firmness. Breast density can only be determined through a mammogram.

Below are the four categories of breast density as seen on mammograms:

Having dense breasts is common, with around 40–50% of women over the age of 40 falling into the dense categories (C or D). Although the reasons for variation in breast density are not fully understood, several factors are associated with higher density, including being younger, having a lower body mass index, and using hormone replacement therapy or the oral contraceptive pill. Ethnicity also plays a significant role, with research indicating that Māori and Asian women are more likely to have dense breasts. Breast density also changes over time, generally decreasing with age, particularly after menopause, as glandular tissue is replaced by more fatty tissue.

Breast density is important for two key reasons:

Increased cancer risk: Women with dense breasts have a higher risk of developing breast cancer compared to women with less dense breasts.

Reduced diagnostic sensitivity: On mammography, dense tissue and cancer both appear white, while fat appears dark, meaning dense tissue can sometimes mask cancer.

What concerns me most is not simply that breast density increases risk or affects mammogram sensitivity. It is that so many women still do not know what breast density is at all.

Women are expected to make informed decisions about their health without always being given the information or support needed to do so. Our bodies carry us through every stage of life. They are our homes, our protectors, our fighters. So, wouldn’t we want access to all the information about them? Even when that information may feel uncomfortable or overwhelming?

Because information is power. And women deserve to have power over their own bodies.

Part of the problem is that breast density is not routinely reported in the BreastScreen Aotearoa programme for women aged 45–69, and there is ongoing debate internationally about how best to communicate this information. Many healthcare providers also report feeling uncertain about how to discuss breast density due to inconsistent evidence and unclear clinical guidance. As a result, women are often left unaware, confused, or unsupported.

This inconsistency is reflected internationally as well. While the United Kingdom does not routinely notify women of breast density, several other countries now require disclosure. For example, breast density notification is implemented across the United States, several Canadian provinces, and Australian states, including Western Australia, South Australia, and New South Wales.

For me, this raises a bigger question: How can women advocate for their health if they are not being fully included in the conversation?

I believe we need significant changes in how women’s health information is communicated. Simply handing someone a pamphlet is not enough. Information needs to be clear, accessible, culturally responsive, and supported by conversations that help women understand what it means for them personally. At the same time, clinicians also need greater education and confidence when discussing breast density, so women are not left feeling frightened or confused. This is especially important in Aotearoa New Zealand, where longstanding inequities continue to affect Māori and Pasifika women.

What I believe is possible is a future where women leave breast screening appointments feeling informed rather than overwhelmed. A future where understanding is valued just as much as diagnosis. A future where women feel empowered to ask questions, seek support, and make decisions about their health with confidence.

That is exactly why my thesis research is focusing on breast density awareness in Aotearoa, New Zealand. Through a nationwide survey, I am exploring women’s current understanding of breast density, whether a short health information sheet can improve knowledge, and women’s personal views around being informed of their breast density.

Currently, there is very little research exploring New Zealand women’s awareness, understanding, and attitudes toward breast density notification. My hope is that this research can help start important conversations and bring women’s health further into the light, where it deserves to be.

So after my very long spiel, I hope something in these words connected with you.

I hope it reminded you that women deserve more than confusion and silence when it comes to their health. They deserve clarity, support, compassion, and access to information that allows them to make informed decisions without feeling lost in the process.

Most of all, I hope it reminds you that none of us are alone in this conversation.

Life can be hard sometimes, so please take care of yourself and the people you love. Check in with your body. Check in with your friends, your mums, your sisters, your aunties, your daughters. Conversations matter. And sometimes they are where change begins.