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The authors provide a timely introduction to the use of predictive testing as an adjunctive service in the management of a precancerous chronic disease, familial adenomatous polyposis (FAP). As they point out, this new technology carries a significant burden for both the caregiver and affected family since it will alter the genetic counseling process, as well as the clinical recommendations for managing FAP. The unique perspective of registry-based research illustrates the value of generational study of a genetic anomaly over a 22-year-period.

The doctor-hospital integrated practice is one possible strategy oncologists may wish to employ in order to stay financially solvent in the current unstable health-care environment. Before entering into an arrangement with a

Testing for adenomatous polyposis coli (APC), the gene responsible for familial adenomatous polyposis (FAP), can now be offered to family members in FAP kindreds. With the availability of this test, genetic counseling has become a crucial tool for helping FAP patients and their relatives understand the syndrome and its implications and for assisting at-risk individuals in making informed decisions about whether or not to undergo genetic testing. Genetic counseling can occur at several time points: when FAP is diagnosed, when an FAP patient is considering reproductive options, when a patient is deciding whether to have his or her children screened, and when an at-risk person is considering genetic testing.

PALO ALTO, Calif--New research into the nature of malignant cells deep within the interior of solid tumors suggests a possible explanation as to why tumors with large hypoxic areas tend to be aggressive and treatment resistant.

COLUMBUS, Ohio--Roxane Laboratories and the Roxane Pain Institute have announced two new scholarship programs for health-care professionals in palliative care medicine for cancer and AIDS.

COLLEGEVILLE, PA--Rhône-Poulenc Rorer Inc. and Applied Immune Sciences, Inc. (AIS) have entered into a definitive agreement and plan of merger providing for the acquisition by Rhône-Poulenc Rorer (through its subsidiary RPR Gencell) of AIS at a price of approximately $7.2 million.

SILVER SPRING, Md--The FDA's Antiviral Drugs Advisory Committee took action on three anti-HIV agents at its most recent meeting, recommending approval for Hoffmann-La Roche's protease inhibitor saquinavir (Invirase) and Glaxo Wellcome's 3TC (Epivir) in combination with other AIDS drugs, and favoring a new indication for Bristol-Myers Squibb's stavudine (d4T, Zerit), to treat patients who no longer respond to zidovudine (AZT, Retrovir).

WASHINGTON--A new report by the General Accounting Office (GAO) shows that the Food and Drug Administration now approves drugs twice as fast as it did 6 years ago. In 1987 the FDA took an average of 33 months to approve new drugs, while by 1992 it was taking only 19 months.

MARINA DEL REY, Calif--Clinical researchers must develop strategies to cope with the various obstacles faced by patients and physicians who want to participate in research trials, said oncologists at the Association of Community Cancer Centers (ACCC) economics conference.

DULUTH, Minn--Community physicians, at least in Minnesota, appear to have the right attitude toward relieving pain in cancer patients but may be deficient in specific areas of knowledge about cancer pain management, say Thomas E. Elliott, MD, and his colleagues with the Minnesota Cancer Pain Project (MCPP), a randomized community trial testing innovative strategies to improve cancer pain management.

SAN ANTONIO--Although the literature suggests that peripheral blood stem cell support for hematologic salvage after high-dose chemotherapy is somewhat less expensive than autologous bone marrow transplant (ABMT), the difference is nowhere near the $80,000 disparity found in diagnostic-related group (DRG)-based reimbursement, Philip Bierman, MD, said at a lymphoma symposium sponsored by the University of Texas M.D. Anderson Cancer Center.

WASHINGTON--A study funded by a $600,000 grant from the National Cancer Institute shows that for a 5-year period the Weekly Reader, a newspaper aimed at schoolchildren, may have had a pro-smoking stance. Since 1991, the weekly has been owned by K-III Holdings, a subsidiary of Kohlberg Kravis Roberts & Co., which until last spring was majority owner of RJR Nabisco, the second largest US tobacco company.

EDMONTON, Canada--Twice daily 1-hour bolus infusions for subcutaneous hydration (hypodermoclysis) of patients with advanced cancer appear to be effective and well tolerated, say Eduardo Bruera, MD, and his colleagues at the University of Alberta. In addition, the study found that a lower dose of hyaluronidase (Wydase), an enzyme used to facilitate the absorption of water, is as effective as a higher dose.

WASHINGTON--The NHLBI (National Heart, Lung, and Blood Institute) has reduced its support for the NCI's tamoxifen (Nolvadex) prevention trial, saying that the enrollment may not produce useful cardiovascular data.

BALTIMORE--Guilford Pharmaceuticals Inc.'s Gliadel biodegradable polymer implants significantly increased survival in a study of 32 patients with malignant glioma undergoing initial surgery. Gliadel wafers or placebo were inserted into the surgical cavity created when the brain tumor was removed, followed 3 weeks later by standard radiation therapy.

In this column, Dr. Alan Nelson, past president of the American Medical Association, has provided a set of goals for oncologic treatment under managed care contracts that can be embraced by all oncologists--choice, broad scope of practice, and communication. But the real message to oncologists is: Work together with internal medicine and primary care physicians to build a system that provides quality care of which everyone can be proud. Such cooperation is needed to help convert these treatment goals into workable contracts with primary care groups, HMOs, and/or insurers.

PHILADELPHIA--New court decisions are putting a damper on the insurance industry's attempts to deny coverage of experimental treatments by writing specific exclusions into their policies. These exclusions most often concern high-dose chemotherapy with autologous bone marrow transplantation (HDC/ABMT), said Karen L. Illuzzi Gallinari, a partner in the New York-based firm of Anderson Kill Olick & Oshinsky.

ROCKVILLE, Md--The Food and Drug Administration has approved a new indication for Roche Laboratories' Roferon-A (interferon alfa-2A recombinant). The agent, previously approved for use in treating hairy cell leukemia and AIDS-related Kaposi's sarcoma, is now also indicated for the treatment of chronic phase, Philadelphia chromosome positive chronic myelogenous leukemia (CML).

PARIS--Nearly 90% of patients with resected Dukes B and C colorectal carcinoma were still alive 3 years after active specific immunization with a new autologous tumor vaccine, researchers from the German Cancer Research Center, Heidelberg, and the University Hospital, Mannheim, Germany, have found.

HOUSTON--The University of Texas-Houston Health Science Center has been selected by the National Institutes of Health to be home to one of eight specialty centers that will conduct research into the effectiveness of alternative medicines used in cancer treatment.

WASHINGTON--Because of frequent inquiries from people needing references to answer those skeptics who question the link between HIV and AIDS, NIAID Director Anthony Fauci asked the Institute to put together a pamphlet explaining it all.

SAN ANTONIO--Physicians who treat HIV-infected patients may need to brace for patient inquiries in light of evidence that low-dose inter-leukin-2 (IL-2, Proleukin) may boost immune function following remission-inducing chemotherapy for AIDS-related malignancies.

NEW HAVEN, Conn--Vincent T. DeVita, Jr., MD, director of the Yale Cancer Center, has been honored with the 1995 Durham City of Medicine Award.

Forty years of research have had a tremendous impact on the treatmentof leukemia in both children and adult's, according to a panel

WASHINGTON--The Agency for Health Care Policy and Research (AHCPR) has awarded 10 research grants to study changes that are reshaping America's health-care system (see list below). The grants total $1.4 million for the first year; most of the projects will be completed in 2 years or less.

WASHINGTON--The Center for the Advancement of Health is working on a 3-year cancer initiative whose purpose is to increase support for psycho-social and biobehavioral research and services for cancer patients, said executive director Jessie Gruman, PhD. The Center was founded in 1992 by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation.

BETHESDA, Md--The lifetime risk of developing cancer for the US population is 44.8% for men and 39.3% for women, according to an analysis of incidence rates from the National Cancer Institute's SEER (Surveillance Epidemiology and End Results) program for 1973 to 1991.

MIAMI BEACH--Richard Hoppe, MD, has been named president-elect of the American Society for Therapeutic Radiology and Oncology (ASTRO). Dr. Hoppe is chairman of the Department of Radiation Oncology at Stanford University School of Medicine. He will take office at the Society's annual meeting to be held in Los Angeles next October.

SEATTLE--Filtering donated blood to remove cytomegalovirus (CMV) proved effective in an NIH-funded study from the Fred Hutchinson Cancer Research Center.

On the Greek island of Kos in the southeast Aegean, there is a cypress covered hill where ancient springs flow and herbs grow in abundance. People searching for good health have been coming to this hill for 25 generations. Hippocrates was born on Kos, and the hill holds the ruins of the ancient healing place, the Asclepieion.