Le donne ad alto rischio (per es. portatrici di BRCA) si pentono della mastectomia di riduzione del rischio — o di aver scelto la sorveglianza?
Se agisci
Sottoporsi a una mastectomia di riduzione del rischio (profilattica)
19%
Se non agisci
Scegliere la sorveglianza intensificata invece della chirurgia
14%
Percentuale di chi poi rimpiange ciascuna scelta. Le barre e il registro completo dei dati compaiono sotto.
Salute
Ultima revisione 2026-07-14
Qualità delle prove 4.25/5
Punteggio di revisione su otto dimensioni rispetto alla
griglia di qualità
. Ogni dimensione valutata da 1 a 5.
D1 Verifica delle fonti
5/5
D2 Autorità e indipendenza delle fonti
5/5
D3 Precisione del tasso di rimpianto
3/5
D4 Comparabilità delle fonti
3/5
D5 Schema di Gilovich
4/5
D6 Qualità della prosa
5/5
D7 Completezza degli avvertimenti
5/5
D8 Qualità del campione
4/5
Media4.25/5
Dati proxy — non esiste alcun sondaggio diretto sul rimpianto per questa decisione. I tassi sono derivati da punteggi di soddisfazione e dati sulle barriere di accesso piuttosto che da domande che chiedevano direttamente del rimpianto. Vedi avvertenze di seguito.
Rimpianto per azione
Sottoporsi a una mastectomia di riduzione del rischio (profilattica)
19%
19% insoddisfatte della procedura in media 14,5 anni dopo (Frost); in una coorte separata il 7% non sceglierebbe di nuovo l'operazione e il 33% ha trovato il risultato estetico diverso dalle attese
Portatrici di BRCA / donne ad alto rischio dopo mastectomia profilattica bilaterale
in media 14,5 anni dopo la procedura
Rimpianto per inazione
Scegliere la sorveglianza intensificata invece della chirurgia
14%
nessun sondaggio diretto sul rimpianto — proxy: la preoccupazione per il cancro sale invece di scendere sotto sorveglianza, e il 14% di chi ha scelto la sorveglianza ha sviluppato un cancro al seno (28/201 su una mediana di 5,9 anni; 9,9% cumulativo a 5 anni)
Portatrici di BRCA / donne ad alto rischio che scelgono la sorveglianza mammaria intensificata
incidenza grezza su un follow-up mediano di 5,9 anni; preoccupazione misurata su 6–8 mesi
% rimpiange questa scelta
Sottoporsi a una mastectomia di riduzione del rischio (profilattica)Scegliere la sorveglianza intensificata invece della chirurgia
19%14%
balanced — Approssimativamente equilibrato — entrambe le scelte comportano un rimpianto simile.
Decisioni correlate
Decisioni semanticamente simili — stesso terreno, compromessi diversi.
At long follow-up, roughly one in five women is dissatisfied with a risk-reducing mastectomy. The largest long-term study — 572 women a mean of 14.5 years after bilateral prophylactic mastectomy at the Mayo Clinic — found 19% dissatisfied with the procedure, alongside 74% who reported diminished emotional concern about developing breast cancer (Frost et al., 2000). That dissatisfaction is mostly about the body rather than the decision: about a third reported an unfavourable effect on satisfaction with body appearance, and a quarter on feelings of femininity. An independent Norwegian cohort of BRCA1/2 carriers pins the narrower figure down — only about 7% would not choose the same operation again, though a third said the cosmetic result was not as expected, and lower satisfaction clustered among women who found the decision process difficult or felt unsupported by their clinicians (Hyldebrandt et al., 2025). The regret that exists tends to attach to reconstruction complications and to decisions that felt externally initiated, not to the cancer-risk reduction the surgery reliably delivers.
The surveillance side has no direct regret survey at all, so its rate is a proxy assembled from two things. First, the harm that materialises: in a Canadian cohort, 14% of women who chose surveillance developed breast cancer (9.9% cumulative at five years), against 6% among those awaiting surgery (Macadam et al., 2021). Second, the burden that persists: on the one measure taken comparably on both arms — cancer worry — surgery lowers it and surveillance does not. A prospective cohort found anxiety fell over six to eight months in women who chose mastectomy but rose in women who chose surveillance, ending higher in the surveillance group (Dick et al., 2022). Developing a cancer is not the same as regretting the choice, and many surveillance-detected cancers are caught early, so the 14% inaction figure is a materialised-harm-plus-worry stand-in, not a measured regret rate.
The two numbers land close together, but the closeness is fragile: it depends on which proxy anchors each side. They are not measuring the same thing — the action rate is long-term dissatisfaction with an irreversible operation, while the inaction rate is cancer incidence plus unresolved worry among women who kept their breasts. Swap the broad 19% dissatisfaction for the narrower 7% who would not choose the surgery again, and the balance tips toward surveillance; anchor the inaction side on the 9.9% five-year cumulative incidence instead of the 14% crude rate, and it tips the other way. On the worry axis alone the surveillance side carries more — the Gilovich-typical pattern in which the road not taken keeps generating unease — but risk-reducing mastectomy is permanent and exacts body-image and reconstruction costs that surveillance never imposes, which is what holds the action-side dissatisfaction up to meet it. None of the underlying data is a US survey of the surveillance arm, and no study asks surveillance-choosers directly whether they would decide differently, so the near-balance is a direction with wide error bars, not a settled equivalence.
Fonti: azione
Registro delle fonti
Ogni numero qui sotto è ciò che ciascuna fonte ha riportato, con la citazione testuale su cui ci siamo basati e come siamo arrivati alla nostra cifra. Clicca su qualsiasi link per verificare direttamente.
[1]JAMA (Frost et al. 2000, Mayo Clinic) — Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy
Articolo peer-reviewed
Among 572 women (94% of survivors), mean 14.5 years after bilateral prophylactic mastectomy: 70% satisfied with the procedure, 11% neutral, 19% dissatisfied; 74% reported a diminished level of emotional concern about developing breast cancer; negative effects were reported on satisfaction with body appearance (36%) and on feelings of femininity (25%)
Estratto
“"Most women (70%) were satisfied with the procedure; 11% were neutral; and 19% were dissatisfied. Among the psychological and social variables, the most striking finding was that 74% reported a diminished level of emotional concern about developing breast cancer. The majority of women reported no change/favorable effects in levels of emotional stability (68%/23%), level of stress (58%/28%), self-esteem (69%/13%), sexual relationships (73%/4%), and feelings of femininity (67%/8%). Forty-eight percent reported no change in their level of satisfaction with body appearance; 16% reported favorable effects. However, 9%, 14%, 18%, 23%, 25%, and 36% reported negative effects in these 6 variables, respectively."
”
Dati originali da
2000-07-19
Consultato
2026-07-14
Calcolo
The action-side anchor. Frost et al. is the largest long-term follow-up of prophylactic mastectomy (n=572, mean 14.5 years, US Mayo Clinic cohort) and the standard reference for durable outcomes. It measures satisfaction, not "regret" directly: 19% were dissatisfied with the procedure at long follow-up, which we take as the action-side proxy for a lingering negative decision outcome. This overlaps with — but is broader than — outright decision regret (see the Hyldebrandt cohort, where only ~7% would not choose the operation again). The 19% dissatisfied largely reflects body-image, femininity, and cosmetic outcomes rather than a wish to have skipped the surgery altogether.
[2]Familial Cancer (Hyldebrandt et al. 2025) — Experiences with risk-reducing mastectomy in Norwegian BRCA1/2 carriers without prior breast cancer
Articolo peer-reviewed
Of 190 BRCA1/2 carriers who had undergone risk-reducing mastectomy: 78.9% (150/190) satisfied and would choose the same procedure again; 13 (6.8%) would not choose the same operation again; 63 women (33%) said the operative result was not as expected; satisfaction with healthcare-system support gave an OR of 5.5 for being satisfied with RRM (p<0.01), and finding the decision difficult lowered the odds (OR 0.2, p=0.02)
Estratto
“"78.9% (150/190) were satisfied with their decision and would choose the same procedure again. [...] 13 (6.8%) [would not have chosen the same operation]. [...] 63 women (33%) expressed that the result was not as expected. [...] Feeling satisfied with support from the health care system gave an OR of 5.5 for being satisfied with having undergone RRM (p < 0.01). Those who found the decision difficult had lower odds of being satisfied (OR 0.2, p = 0.02)."
”
Dati originali da
2025-01-01
Consultato
2026-07-14
Calcolo
Independent corroboration from a Norwegian cancer-unaffected BRCA1/2 cohort (n=190 who had RRM, of 272 respondents). It supplies the cleaner decision-regret figure: 6.8% would not choose the operation again — a floor well below Frost's 19% dissatisfaction, because "dissatisfied with the result" and "would not do it again" are different constructs. The third of women whose result was "not as expected" tracks the same body-image/reconstruction dissatisfaction Frost measures. The finding that a difficult decision process and weak healthcare support predict lower satisfaction is the source for the prose claim that RRM regret concentrates around reconstruction outcomes and decisions that felt externally driven rather than chosen.
Fonti: inazione
Registro delle fonti
Ogni numero qui sotto è ciò che ciascuna fonte ha riportato, con la citazione testuale su cui ci siamo basati e come siamo arrivati alla nostra cifra. Clicca su qualsiasi link per verificare direttamente.
[1]Hereditary Cancer in Clinical Practice (Dick et al. 2022) — Psychological factors and the uptake of preventative measures in BRCA1/2 pathogenic variant carriers: results of a prospective cohort study
Articolo peer-reviewed
Prospective cohort (n=98). Anxiety in the intensified-breast-surveillance (IBS) group rose over 6–8 months (mean ~6.2 → ~6.6), while anxiety in the risk-reducing-mastectomy group, elevated just after test-result disclosure (T1 ~8.2, up from ~7.6 at baseline), fell to ~5.7 over the same period; elevated post-disclosure anxiety predicted opting for RRM (OR 1.2, p<0.01)
Estratto
“"Baseline anxiety levels in women opting for RRM were high but decreased over time, while they increased in women opting for intensified breast surveillance (IBS). [...] Elevated levels of anxiety after genetic test result disclosure (T1) were associated with the decision to undergo RRM (p < 0.01; OR = 1.2, 95% CI = 1.05–1.42)." [Reported group means: RRM T1 8.2 → T2 5.7; IBS T1 6.2 → T2 6.6, so at follow-up the surveillance group's mean anxiety (6.6) exceeded the mastectomy group's (5.7).]
”
Dati originali da
2022-12-01
Consultato
2026-07-14
Calcolo
The construct-matched half of the inaction proxy, and the reason the two sides can be compared at all. On the one axis measured comparably on both arms — psychological burden / cancer worry — surgery lowers it and surveillance does not: the surveillance group's anxiety rose and ended higher than the mastectomy group's. This is the residual worry that is the honest analogue of "regret" for the surveillance choice. It is not a regret rate and yields no percentage; it fixes the direction of the worry burden, not the magnitude.
[2]Current Oncology (Macadam et al. 2021) — Prophylactic Surgery in the BRCA+ Patient: Do Women Develop Breast Cancer While Waiting?
Articolo peer-reviewed
Of 333 BRCA carriers, 201 chose surveillance and 132 chose prophylactic mastectomy with immediate reconstruction. 28/201 surveillance patients (13.9%) developed invasive breast cancer vs 8/132 (6.1%) in the surgery group; 5-year cumulative incidence 9.9% (surveillance) vs 4.9% (surgery). 89% of surveillance-detected tumours were <20 mm
Estratto
“"During this period, 6% of patients developed breast cancer compared with a 14% incidence of breast cancer in patients choosing surveillance. [...] At five years, the cumulative incidence of breast cancer in the surveillance group was 9.9% compared with 4.9% in the PM/IBR group." [Results: "201 patients chose S, 132 chose PM/IBR"; "Twenty-eight of the 201 surveillance patients and eight of 132 patients in the PM/IBR group developed invasive breast cancer"; median surveillance follow-up 5.9 yr; 89% of tumours <20 mm.]
”
Dati originali da
2021-02-01
Consultato
2026-07-14
Calcolo
The materialized-harm anchor for the inaction proxy. The inaction-side rate is set at 0.14 — the crude cited figure: 28 of 201 surveillance-choosers (13.9%) developed invasive breast cancer in this Canadian cohort over a median 5.9 years. No worry adjustment is applied; an earlier draft nudged this to 0.15 to "fold in" the rising cancer worry, but that increment has no source basis (Dick 2022 yields no regret percentage) and has been removed. The 5-year cumulative incidence of 9.9% is the alternative anchor; choosing it instead would move the rate to ~0.10 and the delta to ~0.09. Developing cancer is not itself "regret" — 89% of the surveillance-detected tumours were under 20 mm, i.e. screen-caught early, and no survey asks surveillance-choosers whether they regret the decision — so this is a materialized-harm-plus-worry proxy, not a regret survey. It is the closest available inaction anchor and is deliberately flagged as a proxy. Boundary call: with action 0.19 and inaction 0.14 the delta is exactly 0.05, sitting right on the rubric's balanced/action_dominates line (|delta| < 0.05 is balanced). The label is deliberately kept at "balanced" rather than tipped to "action_dominates" because the two rates are non-comparable proxies (long-term dissatisfaction vs materialized cancer incidence); a signed delta at the boundary between them carries no interpretable direction, so "neither side clearly dominates" is the honest reading.
Avvertenze
Entrambi i tassi sono proxy provenienti da coorti non comparabili, e questa voce è pubblicata con un'avvertenza di proxy per questa ragione. Il 19% del lato azione è un dato di soddisfazione/insoddisfazione misurato in media 14,5 anni dopo la mastectomia profilattica bilaterale (Frost 2000, USA, n=572); il dato più pulito di rimpianto della decisione, da una coorte BRCA indipendente, è molto più basso — circa il 7% non sceglierebbe di nuovo l'operazione (Hyldebrandt 2025, Norvegia, n=190), con un terzo che riferisce un risultato estetico diverso dalle attese. Il 14% del lato inazione non è affatto un tasso di rimpianto: è ancorato al 14% di chi ha scelto la sorveglianza e ha sviluppato un cancro al seno (Macadam 2021, Canada, n=201; 28/201 su una mediana di 5,9 anni, 9,9% cumulativo a 5 anni), un danno materializzato, con la traiettoria in salita della preoccupazione per il cancro sotto sorveglianza (Dick 2022, Europa, n=98) come conferma dal costrutto corrispondente. Nessun sondaggio pubblicato chiede direttamente alle donne che hanno scelto la sorveglianza se se ne pentono, quindi il tasso di inazione porta un'ampia incertezza. I due lati misurano costrutti diversi — insoddisfazione a lungo termine per una chirurgia irreversibile contro incidenza di cancro più preoccupazione residua — quindi il delta di 0.05 sta al confine dell'equilibrio e non è una grandezza interpretabile in nessuna direzione; va letto come "nessun lato domina chiaramente", non come un'uguaglianza precisa né come un maggior rimpianto dell'azione. Quel quasi-equilibrio è anche, in parte, un artefatto della scelta delle ancore: prendere per il lato azione il dato più pulito di rimpianto della decisione (il 7% di Hyldebrandt che non sceglierebbe di nuovo, invece del 19% di insoddisfazione di Frost) capovolgerebbe il segno verso l'inazione, mentre prendere per il lato inazione l'incidenza cumulativa a cinque anni del 9,9% allargherebbe il divario a circa 0.09. L'equilibrio è quindi una proprietà dei proxy scelti, non un risultato. L'unico asse misurato in modo comparabile su entrambi i bracci, il carico psicologico, pende verso il lato della sorveglianza: la preoccupazione scende dopo la chirurgia e sale sotto sorveglianza, il tipico schema di inazione di Gilovich. Di contro, la mastectomia profilattica è irreversibile e comporta costi di immagine corporea, femminilità e complicanze della ricostruzione che la sorveglianza non ha, ed è ciò che tiene l'insoddisfazione del lato azione abbastanza alta da compensare. Le popolazioni sono statunitense, norvegese, canadese ed europea; nessuno dei dati di rimpianto/soddisfazione è un sondaggio statunitense del braccio di sorveglianza. Il rimpianto dopo la mastectomia di riduzione del rischio si concentra sulle complicanze della ricostruzione, sulle aspettative estetiche disattese e sulle decisioni percepite come avviate dall'esterno anziché scelte (Hyldebrandt 2025) — non sulla riduzione del rischio di cancro in sé, che la chirurgia fornisce in modo affidabile.
