The average lifetime risk of breast cancer for a woman in the United States has been estimated at 12.3% (ie, 1 in 8 women). 1 For 2018, the American Cancer Society (ACS) estimates that 63,960 cases of female carcinoma in situ of the breast and 268,670 cases of invasive breast cancer (266,120 women and 2,550 men) will be diagnosed in the United States. 2 About 41,400 deaths are estimated for 2018. 3 The good news is that death rates have been falling on average NCCN

ICU patients who were subsequently readmitted have a higher risk of death and longer LOS after adjusting for severity of illness. However, readmission rates were not associated with severity-adjusted mortality or LOS. Those data indicate that ICU readmission may capture other aspects of hospital performance and may be complementary to these measures.

The risk of death was substantially higher in patients with DNR orders after adjusting for propensity scores and other covariates. Whereas the increased risk may reflect patient preferences for less intensive care or unmeasured prognostic factors, the current findings highlight the need for more direct evaluations of the quality and appropriateness of care of patients with DNR orders.

OBJECTIVE:To compare the use of do-not-resuscitate (DNR) orders in African-American and white patients using a large, multisite, community-based sample. MEASUREMENTS:Our sample included 90,821 consecutive admissions to 30 hospitals in a large metropolitan region with six nonsurgical conditions from 1993 through 1995. Demographic and clinical data were abstracted from medical records. Admission severity of illness was measured using multivariate risk-adjustment models with excellent discrimination (receiver-operating characteristic curve areas, 0.82-0.88). Multiple logistic regression analysis was used to determine the independent association between race and use of DNR orders, adjusting for age, admission severity, and other covariates. MAIN RESULTS:In all patients, the rate of DNR orders was lower in African Americans than whites (9% vs 18%; p Ͻ .001). Rates of orders were also lower ( p Ͻ .001) among African Americans in analyses stratified by age, gender, diagnosis, severity of illness, and in-hospital death. After adjusting for severity and other important covariates, the odds of a DNR order remained lower ( p Ͻ .001) for African-Americans relative to whites for all diagnoses, ranging from 0.38 for obstructive airway disease to 0.71 for gastrointestinal hemorrhage. Results were similar in analyses limited to orders written by the first, second, or seventh hospital day. Finally, among patients with DNR orders, African Americans were less likely to have orders written on the first hospital day and more likely to have orders written on subsequent days. CONCLUSIONS:The use of DNR orders was substantially lower in African Americans than in whites, even after adjusting for severity of illness and other covariates. Identification of factors underlying such differences will improve our understanding of the degree to which expectations for care differ in African American and white patients.

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