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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.

Esserman and Kerlikowske have done an excellent job in reviewing the factual information on screening mammography for women age 40 to 49 years. Their review builds on some previously published work by Kerlikowske and colleagues, particularly their meta-analysis [1]. This meta-analysis was important, in that it addressed the issue of timing in relation to mammography screening in women 40 to 49 years old, as compared with those 50 to 69 years of age. The combined data of eight randomized trials clearly demonstrated that there was absolutely no benefit of mammography for women age 40 to 49 at 7 to 9 years after the initiation of screening. In contrast, for women age 50 to 69, there was a substantial and statistically significant reduction in breast cancer mortality.

We easily believe that which we wish.-Pierre Corneille (1606-1684)

Our arsenals for fighting off bacteria are so powerful, and involve so many different defense mechanisms, that we are in more danger from them than the invaders. We live in the midst of explosive devices; we are mined.

Emmanoulides, Miles, and Mitsuyasu have written an excellent review summarizing our current understanding of the pathogenesis of AIDS-related Kaposi's sarcoma (AIDS/KS). The authors cover what is currently well established and also provide their viewpoint on future developments in AIDS/KS. My commentary will highlight some of the major questions related to this complex disease.

Although there is general agreement that screening women over age 50 years with mammography reduces mortality from breast cancer, there has been controversy over the effectiveness of mammography in women 40 to 49 years old. Until 1993, the most widely accepted recommendation for screening mammography included baseline mammography between ages 35 and 40, mammography every 1 to 2 years between ages 40 and 50, and annual mammograms after age 50.

Drs. Coleman and Stevenson have done a superb job in covering diverse aspects of biology relevant to clinical radiotherapy. They note that recent advances in understanding DNA repair may lead to practical applications in radiotherapy. For example, a dual benefit of unraveling DNA repair mechanisms may be to identify which tumors are the most likely to respond to therapeutic radiation and which patients are most likely to develop radiation-induced tumors. The authors point out that gene induction observed in vitro following large radiation doses may not necessarily be relevant to doses employed clinically. Coleman and Stevenson highlight the importance of defining the sequence of genes induced by radiation in clinically relevant doses.

The occurrence of Kaposi's sarcoma (KS) in patients with HIV infection is more than 7,000 times higher than in the non-HIV infected population. The reason for this association is unclear but may involve decreased immune surveillance as a result of the profound cellular immune deficiency caused by HIV, a sexually transmitted KS-inducing virus, whose KS-transforming capabilities may be enhanced by HIV, or a direct or indirect effect of HIV itself in susceptible individuals.

Improved understanding of the underlying biologic mechanisms that pertain to radiation oncology is providing an explanation for the cellular and tissue responses to ionizing radiation and is leading to the potential for novel

SEATTLE--In a retrospective study of 39 children (aged 4 to 12 years) given patient-controlled analgesia (PCA) for pain associated with bone marrow transplantation (BMT), researchers found that 95% of children successfully mastered PCA to control their pain.

SEATTLE--In the 1970s, Hawaii led the way in state efforts at controlling health-care costs while expanding coverage; in the 1980s, physicians and insurers in California forged ahead with managed care; and in the 1990s, Oregon has led the way in prioritizing health services to provide greater access to care.

The issues, cases, decisions and situations discussed by Severin indicate that, fortunately in one area and unfortunately in another, the more things change, the more they stay the same. Furthermore, his article raises an important medicolegal policy issue.

Oral morphine remains the drug of choice for most patients with severe cancer pain, and the sustained-release form (MS-Contin, Roxanol SR), has certain advantages, Ronald Blum, MD, said at a conference sponsored by Cancer Care, Inc.

BETHESDA, Md--The Oncologic Drugs Advisory Committee (ODAC) has recommended that Sclerosol (sterile aerosol talc) be approved for use in relieving fluid around the lungs (malignant pleural effusion) of patients with cancer. The sponsor for Sclerosol, Bryan Corporation (Woburn, Mass), presented nine controlled trials (six articles and three abstracts), with an average of 12 patients each, in support of the talc.