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PALM SPRINGS, Calif--Women often develop idiosyncratic ideas about their risk for breast cancer, Mary Jane Massie, MD, said at the Academy of Psychosomatic Medicine in a session on counseling high-risk women. And the higher the perceived risk, the less likely these women may be to confront their fears and comply with preventive regimens such as breast self-exam (BSE).

Drs. Finlayson and Eisenberg provide a timely, in-depth review of total pelvic exenteration in the palliation of incurable pelvic cancer. The authors conclude that total pelvic exenteration has a role as a palliative treatment for patients with recurrent pelvic cancer-a conclusion that I believe remains unproven.

We strongly agree with the authors that, although there is no compelling evidence to suggest that nonionizing electromagnetic fields represent a public health hazard, there is sufficient evidence of magnetic- and electric field-induced biologic effects to continue scientific investigation of this issue.

Do not resuscitate (DNR) orders have become an integral part of the care of the terminally ill patient. Often, the decision whether or not to resuscitate a patient in the event of cardiopulmonary arrest must be made by the patient's family members. This is a difficult decision that is made at an emotionally trying time. Our study investigated the satisfaction, understanding, and feelings of families who sign DNR orders for their relatives. We are not aware of any other studies that have evaluated this aspect of the DNR order.

The discussion by Freifeld and Pizzo is a comprehensive summary of an important recent trend: the attempt to identify low-risk patients with fever and neutropenia and relax their therapy appropriately. It is not surprising that a summary from these authors would be definitive. Dr. Pizzo and his colleagues have defined many central elements of the therapy of fever and neutropenia: that broad-spectrum antibiotics should be continued after patients become afebrile while they remain neutropenic [1]; that an antifungal agent, amphotericin, should be added to prevent potentially serious fungal superinfection when patients remain febrile and neutropenic after 7 days [2]; and that monotherapy using ceftazidime alone is as effective as combination therapy with a semisynthetic penicillin and an aminoglycoside, particularly for low-risk patients [3]. Their current review catalogs recent attempts to define less aggressive, costly, and restrictive therapy for low-risk patients with fever and neutropenia. I would add only a few comments based on our work at the Dana-Farber Cancer Institute.

Treatment of fever and neutropenia in cancer patients has been recognized for 30 years as a medical emergency, requiring prompt in-hospital evaluation and institution of broad-spectrum intravenous (IV) antibiotics. This action

Low-frequency electromagnetic radiation had previously been thought to cause human injury only by generation of excess heat or by shock from direct contact with electric current. Information accumulating over the past few

NEW YORK--Dexrazoxane (Zine-card), which was developed in Great Britain in the 1960s as an anticancer drug, is extremely effective in blocking the cardiotoxic effects of doxorubicin, said James L. Speyer, MD, professor of clinical medicine, Department of Oncology, New York University Medical Center.

FLUSHING, NY--The New York Hospital-Cornell Medical Center has appointed Dattatreyudu Nori, MD, a pioneer in the subspecialty of brachytherapy, to the position of professor and chairman of the Department of Radiation Oncology.

Screening methods and programs are critical strategies for the early detection and timely treatment of some cancers. Established methods for early detection of cancer include mammography, clinical breast examination (CBE), the Papanicolaou (Pap) test, proctosigmoidoscopy, fecal occult blood test (FOBT), and digital rectal examination (DRE). To examine changes in the reported use of selected cancer screening tests, the National Cancer Institute analyzed data from CDC's National Health Interview Survey (NHIS) for 1987 and 1992 to calculate rates of use and compared these rates with the national health objectives for the year 2000. This analysis suggests that, although the use of these tests increased, substantial progress is needed to meet the objectives.

BALTIMORE--Academic medical centers must now operate in a health-care environment that "has become increasingly unfriendly, even hostile economically," said former New England Journal of Medicine editor Arnold S. Relman, MD.

WASHINGTON--Nancy L. Kasse-baum (R-Kan), chairman of the Senate Labor and Human Resources Committee, expects the Committee to complete action in late March on her bill to reform the US Food and Drug Administration (FDA). The bill would then be forwarded to the full Senate for a vote.

This paper is a very interesting economic analysis of workplace mammography screening programs. Especially important is the discussion of the effect of disease prevalence on the cost-effectiveness of workplace screening programs.

CHICAGO--A new critical pathway for radical prostatectomy introduced at Chicago's Weiss Memorial Hospital has lowered hospital stays for these patients to a mean of 1.7 days, compared with 4.6 days for patients treated under the previous protocol. The shorter stays did not affect surgical outcome or reduce patient satisfaction, report Gerald W. Chodak, MD and his colleagues at the University of Chicago Medical Center.

WASHINGTON--Studies of two new protease inhibitors, used in combination with currently available anti-HIV agents, show good results in reducing viral load. Furthermore, studies of a new test for determining viral load indicate a significant relationship between high viral load and faster disease progression.

Since the initial publication of Dr. Susan Love's Breast Book 5 years ago, every oncologist has seen this guide in the arms of many patients. When I read the cover to the second edition, stating that the book was "fully revised," I could not imagine how the universally excellent first edition could have been improved. The original text, in fact, remains essentially unchanged in the second edition. What has changed is the addition of some 138 pages addressing recent developments or expanding on various issues.

The evaluation of efforts to prevent tobacco use among adolescents requires accurate surveillance of both smoking prevalence and smoking initiation rates. Although several surveillance systems provide timely data about adolescent smoking prevalence, data characterizing rates of smoking initiation among adolescents have been limited. To improve characterization of trends in smoking initiation among young persons, data from the Tobacco Use Supplement of the 1992 and 1993 Current Population Surveys (CPS) were used to estimate smoking initiation rates for persons who were adolescents (age 14 to 17 years) or young adults (age 18 to 21 years) during 1980 to 1989. This report summarizes the results of that analysis.

PARIS--Although well over 1,000 patients with breast cancer are now registered with the North American Autologous Bone Marrow Transplant Registry each year, it is still unclear whether these women actually have something to gain in the long run from dose-intensified regimens, Dr. Gabriel Hortobagyi, of M.D. Anderson Cancer Center, said at the Sixth International Congress on Anti-Cancer Treatment (ICACT).

NEW HAVEN, Conn--Lee Philip Schacter, PhD, MD, has been named associate director for clinical trials for the Yale Cancer Center. In that role, he will oversee the clinical research projects on experimental cancer treatment taking place at the Center. Dr. Schacter comes to Yale from Bristol-Myers Squibb, where he was a director of the clinical cancer research program.

Researchers at Aronex Pharmaceuticals, the Katholieke Universiteit Leuven, the National Cancer Institute, the University of California at San Francisco, and the Southern Research Institute reported laboratory results indicating that AR-177, a new anti-HIV drug, inhibits viral production through a pathway distinct from other established and experimental approaches. The studies were reported in the November 1995 issue of Antimicrobial Agents and Chemotherapy.

SEATTLE--Researchers at the University of Illinois at Chicago are using novel approaches to identify and analyze the genes involved in making cancer cells more resistant, or more sensitive, to chemotherapy agents, Igor Roninson, PhD, head of the Molecular Oncology Division, said at a symposium held in conjunction with the American Society of Hematology annual meeting.

To do better than merely survive under managed care, oncologists who are accustomed to fee-for-service practice must plan new strategies, particularly if they expect to stay in practice more than a few more years.

A task force of preventive health specialists recently recom its, significantly change the use of some screening tests, and ensure that several newer immunizations are routinely provided.

FRANKLIN, Tenn--On Sunday, June 2, 1996, more than 600 communities throughout the United States will hold celebrations of life as part of the ninth annual National Cancer Survivors Day. The event recognizes the country's more than 8 million cancer survivors (2% of the population) and serves as a platform to call attention to the barriers that prevent many Americans from receiving state-of-the-art cancer treatment.

MARINA DEL REY, Calif--By modifying the standard "Walsh procedure" for radical retropubic removal of the prostate, UCLA researchers have seen a much faster and more complete return of urinary continence, Jean B. deKernion, MD, chief, Division of Urology, UCLA School of Medicine, reported at a conference jointly sponsored by UCLA and the Clark Urological Cancer Center.

BETHESDA, Md--Cancer patients may be more likely to enter treatment trials if the medical centers are near their own homes. With this in mind, the National Cancer Institute and the Division of Cancer Prevention and Control developed the Community Clinical Oncology Program (CCOP).

LOS ANGELES--Cancer patients with breakthrough pain episodes report more severe pain than those who do not have breakthrough pain, a study from Memorial Sloan-Kettering Cancer Center has shown.

FORT LAUDERDALE, Fla--The National Comprehensive Cancer Network (NCCN) unveiled preliminary clinical practice guidelines for eight diseases at its first annual conference (see photograph below). The network now includes 14 institutions nationwide with the addition of its newest member, Roswell Park Cancer Institute.

A study demonstrating the existence of a new transmissible herpesvirus may lead to additional therapeutic approaches for Kaposi's sarcoma (KS), a cancer that remains one of the major AIDS-associated malignancies. The study findings were reported at The American Society of Hematology's 37th Annual Meeting in Seattle.

LISBON--Clarithromycin prophylaxis for Mycobacterium avium complex (MAC) may provide additional benefits to AIDS patients by preventing the development of common opportunistic infections, Mark Pierce, MD, said at the Third International Conference on the Macrolides, Azalides, and Streptogra-mins, sponsored by Abbott Laboratories.