Undoubtedly, the medical aspects of mammary carcinoma-its cause, early detection and treatment-have received considerable attention. Rightly so. The disease is widespread and may be regarded as one of the most important health hazards for women. The psycho-social aspects of the problem, however, have so far received far less attention. Yet these aspects are of the utmost importance, as became evident once more during our workshop conference, of which this book presents the proceedings. It dealt with two aspects of psycho-social problems resulting from breast cancer: 1. The psycho-social difficulties that women may face when the diagnosis is given and when mastectomy has been performed. 2. The psycho-social factors that play a role in participation or non participation in screening programmes for mammary carcinoma. These two areas, and some related topics, have been the subject of a 2-day meeting in Brussels, organized by the International Health Foundation. A number of papers was presented and discussed. The meeting ended with a general discussion. The editors are grateful to the participants for their willingness to share their knowledge and ideas with them. It is hoped that this book will be of some help to all those who are involved in the treatment and the care of women who are to undergo or who have had a mastectomy and to those who plan the strategy of screening programmes for carcinoma of the breast.

The decision taken during the First International Congress on the Menopause in June 1976 to repeat the exercise 2 years later turned out to be a good one. In the last few years much work has been done on the subject of the menopause. I t is, of course, a subject of many facets, but of particular importance recently has been the work done as a result of the reports appearing in 1975 and 1976 alleging an increase in the incidence of endometrial carcinoma in women who had used oestrogens, and of other effects, some beneficial others deleterious, reportedly seen when oestrogens were administered. 1978 seemed the right time to re-assess the situation, and the Second Inter national Congress on the Menopause provided a good platform. The congress was held in Jerusalem in June 1978. It took the form of a series of 12 workshops, each of which, within a prescribed framework, was planned and presided over by a moderator experi enced in that particular field. The 12 moderators were free to organize their sessions in whichever way they wished, and to invite whoever they wished to present papers and to join in the discussions. In addition the workshops were open to anyone who wished to attend."

Despite a plethora of theories, premenstrual syndrome (PMS) has remained an enigma. There has persisted in the literature a constant conflict as to the existence of the syndrome, a question as to whether it is one syndrome or several, and a debate as to whether the origin is psychic, somatic, or both. Advances in endocrinology, specifically in radioligand assays, allowing for accurate hormone measurements, have precipitated a more scientific evaluation of PMS in recent years. Nonetheless, diffi culties have persisted in accumulating well-documented data because of the protean nature of the syndrome. Indeed, even at this time, the question of what requires measurement during the follicular phase of the cycle and the premenstrual phase remains unresolved, and is difficult to place in perspective. In view of the persisting conflict between the organic and the psychological schools of thought, we, the editors of this book, considered the Sixth International Congress of Psychosomatic Obstetrics and Gynecology to be an ideal venue for a workshop in which both parties could be encouraged to participate. Towards this end, the organizing committee of the Inter national Society of Psychosomatic Obstetrics and Gynecology (ISPOG) was approached, and their response was extremely encouraging. In this respect, we wish to record our thanks to the Scientific Committee oflSOPG for allowing this workshop to be organized under their auspices, but totally under our direction. We, in turn, stand responsible for the format and content of the workshop."

The Fourth International Congress on the Menopause was held in Lake Buena Vista, Florida, USA in October - November 1984. It was different from the previous meetings held under the auspices of the International Menopause Society in three respects: the duration of the Congress was extended to five days, plenary sessions were held on each day, and the scope of the subject matter was expanded to provide a total or holistic overview of the subject - hence the theme for the Congress 'Climacteric Medicine and Science: A Societal need. ' In recent years there has been an increased interest in the menopause and middle year aging by scientists and clinicians in fields as diverse as anthropology, urodynamics, nutrition and exercise physiology, while 'newer' issues in clinical medicine, such as osteoporosis prevention and management, attracted specialists in nuclear immaging techniques and internal medicine. Over 120 invited speakers plus numerous contributors to the free communication, special lectures and the poster sessions provided a virtual cornucopia of information on the menopause, that has indeed brought a newer perspective to a subject previously the domain of a single specialty, the gynecologist, and dominated by a single therapy, estrogen replacement.

During the last decade it has become evident that the brain is an important target for hormones. Although it has been discovered only recently that the brain contains numerous peptide hormones, the role of pituitary and hypo thalamic hormones in brain activity has been the subject of basic studies for quite some time. Peptide hormones are involved in mental performance. pain perception, food and water metabolism. sleep. sexual behaviour and nursing behaviour, and disturbances in the hormonal climate of the brain may be associated with psychopathology. cognitive disturbances and. possibly. addic tion. The clinical influence of neurohypophysial hormones and their frag ments is studied today on learning and memory. on inadequate behaviour and addiction, in Parkinson's disease. Lesch-Nyhan syndrome. depression and schizophrenia. Fragments of adrenocorticotrophin have been shown to affect motivation, concentration and attention. and neuropeptides derived from -lipotrophin are probably involved in psychopathology. Thyrotrophin releasing hormone has been implicated in depression. and lutein-releasing hormone in sexual disturbances. In spite of the impressive experimental data; clinical results to date have been controversial and. to some extent. anecdotal. In some cases they have been exciting. and in others disappointing. It was against this background that the International Health Foundation decided to organize and sponsor their workshop on 'The brain as an endo crine target organ in health and disease' at which the papers appearing in this book were presented."

This book contains a consensus on menopause research, a consensus reached during the First International Congress on the Menopause in June, 1976. The Congress brought together about 165 people, most of whom are engaged in research in this field, in the resort town of La Grande Motte, near Montpellier, France. It was planned so that the main emphasis would be on the exchange of information in small Workshop sessions. Workshop Chairmen were asked to present summaries of their deliberations at the closing session. It is these summaries that form the essence of this text. The Congress also included six Free Communications sessions. They are represented in this book by a small number of papers printed in full (selected from some 40 contributions in all) that in the opinion of the editors, contain data that particularly complement the Workshop summaries. All other papers are mentioned in these Pro ceedings by titles and by the name, affiliation and address of the first author. Organizing this Congress was a stimulating and heart-warming experience. It was done by the staff of the International Health Foundation in Brussels and Geneva, under the considerate auspices of the American Geriatric Society and the Medical Faculty of the University of Montpellier. We are deeply grateful to these two bodies."

Three International Congresses on the Menopause have been held during the last five years, evidence of the explosive increase in the scient ific study of this subject. The first, held in La Grande Motte, near Montpellier, France, inJune 1976, was designed to provide a consensus on menopause research (van Keep et al., 1976). The second, held in Jerusalem, was planned to assess the developing research (van Keep et al., 1979). The objective of the third congress, convened inJune 1981 in Ostend, Belgium, under the auspices of the International Menopause Society, was to explore areas of controversy in basic understanding and in the therapeutic advances relating to the climacteric. The workshop moderators were selected because of their acknow ledged leadership in menopause research, and each was invited to arrange a workshop on a specific area of interest or concern. The moderators, whilst being given a free hand as far as the selection of invited speakers was concerned, were asked to allow plenty of time for open discussion. In particular, they were encouraged to stimulate debate about controversial issues."