As mulheres de alto risco (p. ex., portadoras de BRCA) se arrependem da mastectomia redutora de risco — ou de ter escolhido a vigilância?
Se você agir
Fazer uma mastectomia redutora de risco (profilática)
19%
Se você não agir
Escolher vigilância intensificada em vez de cirurgia
14%
Porcentagem de quem mais tarde se arrepende de cada escolha. As barras e o registro completo aparecem abaixo.
Saúde
Última revisão 2026-07-14
Qualidade das evidências 4.25/5
Pontuação de revisão em oito dimensões segundo a
grelha de qualidade
. Cada dimensão pontuada de 1 a 5.
D1 Verificação das fontes
5/5
D2 Autoridade e independência das fontes
5/5
D3 Precisão da taxa de arrependimento
3/5
D4 Comparabilidade das fontes
3/5
D5 Padrão de Gilovich
4/5
D6 Qualidade da prosa
5/5
D7 Completude das ressalvas
5/5
D8 Qualidade da amostra
4/5
Média4.25/5
Dados proxy — não existe nenhuma pesquisa direta sobre arrependimento para esta decisão. As taxas são derivadas de pontuações de satisfação e dados de barreiras de acesso em vez de perguntas que perguntavam diretamente sobre arrependimento. Veja advertências abaixo.
Arrependimento por ação
Fazer uma mastectomia redutora de risco (profilática)
19%
19% insatisfeitas com o procedimento em média 14,5 anos depois (Frost); numa coorte separada, 7% não escolheriam a operação de novo e 33% acharam o resultado estético diferente do esperado
Portadoras de BRCA / mulheres de alto risco após mastectomia profilática bilateral
média de 14,5 anos após o procedimento
Arrependimento por omissão
Escolher vigilância intensificada em vez de cirurgia
14%
sem pesquisa direta de arrependimento — proxy: a preocupação com o câncer sobe em vez de cair sob vigilância, e 14% das que escolheram vigilância desenvolveram câncer de mama (28/201 numa mediana de 5,9 anos; 9,9% acumulado em 5 anos)
Portadoras de BRCA / mulheres de alto risco que escolhem vigilância mamária intensificada
incidência bruta numa mediana de 5,9 anos de acompanhamento; preocupação medida ao longo de 6–8 meses
% se arrependem desta escolha
Fazer uma mastectomia redutora de risco (profilática)Escolher vigilância intensificada em vez de cirurgia
19%14%
balanced — Mais ou menos equilibrado — ambas as opções implicam arrependimento semelhante.
Decisões relacionadas
Decisões semanticamente semelhantes — mesmo terreno, compromissos diferentes.
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.
Fontes: acção
Registro de evidências
Cada número abaixo é o que cada fonte relatou, com a citação literal em que nos baseamos e como chegamos ao nosso valor. Clique em qualquer link para verificar diretamente.
[1]JAMA (Frost et al. 2000, Mayo Clinic) — Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy
Revisado por pares
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%)
Trecho
“"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."
”
Dados da fonte de
2000-07-19
Acessado
2026-07-14
Cálculo
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
Revisado por pares
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)
Trecho
“"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)."
”
Dados da fonte de
2025-01-01
Acessado
2026-07-14
Cálculo
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.
Fontes: inacção
Registro de evidências
Cada número abaixo é o que cada fonte relatou, com a citação literal em que nos baseamos e como chegamos ao nosso valor. Clique em qualquer link para verificar diretamente.
[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
Revisado por pares
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)
Trecho
“"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).]
”
Dados da fonte de
2022-12-01
Acessado
2026-07-14
Cálculo
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?
Revisado por pares
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
Trecho
“"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.]
”
Dados da fonte de
2021-02-01
Acessado
2026-07-14
Cálculo
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.
Ressalvas
Ambas as taxas são proxies de coortes não comparáveis, e esta entrada é publicada com uma divulgação de proxy por essa razão. Os 19% do lado da ação são um número de satisfação/insatisfação medido em média 14,5 anos após a mastectomia profilática bilateral (Frost 2000, EUA, n=572); o número mais limpo de arrependimento da decisão, de uma coorte BRCA independente, é muito mais baixo — cerca de 7% não escolheriam a operação de novo (Hyldebrandt 2025, Noruega, n=190), com um terço relatando que o resultado estético não foi o esperado. Os 14% do lado da inação não são de forma alguma uma taxa de arrependimento: estão ancorados nos 14% das que escolheram vigilância e desenvolveram câncer de mama (Macadam 2021, Canadá, n=201; 28/201 numa mediana de 5,9 anos, 9,9% acumulado em 5 anos), um dano materializado, com a trajetória ascendente da preocupação com o câncer sob vigilância (Dick 2022, Europa, n=98) como corroboração de construto equivalente. Nenhuma pesquisa publicada pergunta diretamente às mulheres que escolheram a vigilância se elas se arrependem, então a taxa de inação carrega ampla incerteza. Os dois lados medem construtos diferentes — insatisfação de longo prazo com uma cirurgia irreversível versus incidência de câncer mais preocupação residual — de modo que o delta de 0.05 fica na fronteira do equilíbrio e não é uma magnitude interpretável em nenhuma direção; deve ser lido como "nenhum lado domina claramente", não como uma igualdade precisa nem como a ação sendo mais lamentada. Esse quase-equilíbrio é também, em parte, um artefato da seleção de âncoras: tomar o número mais limpo de arrependimento da decisão para o lado da ação (os 7% de Hyldebrandt que não escolheriam de novo, em vez dos 19% de insatisfação de Frost) inverteria o sinal em direção à inação, enquanto tomar a incidência acumulada de 9,9% em cinco anos para o lado da inação alargaria a diferença para cerca de 0.09. O equilíbrio é, portanto, uma propriedade de quais proxies foram escolhidos, não um achado. O único eixo medido de forma comparável nos dois braços, a carga psicológica, inclina-se para o lado da vigilância: a preocupação cai depois da cirurgia e sobe sob vigilância, o padrão de inação típico de Gilovich. Contra isso, a mastectomia profilática é irreversível e carrega custos de imagem corporal, feminilidade e complicações de reconstrução que a vigilância não tem, e é isso que mantém a insatisfação do lado da ação alta o suficiente para compensar. As populações são americana, norueguesa, canadense e europeia; nenhum dos dados de arrependimento/satisfação é uma pesquisa americana do braço de vigilância. O arrependimento após a mastectomia redutora de risco concentra-se nas complicações da reconstrução, nas expectativas estéticas não atendidas e nas decisões que pareceram iniciadas de fora em vez de escolhidas (Hyldebrandt 2025) — não na redução do risco de câncer em si, que a cirurgia entrega de forma confiável.
