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Summary Changes in the pattern of presentation of carcinoma of the uterine cervix between 1960 and 1975 were studied using the records of 3193 patients registered with the East Anglian Cancer Registration Bureau. Between 1963 and 1968, an increased registration rate for invasive tumours was largely attributable to increased registrations of Stage I and I1 lesions in the 35 to 49 age group. After 1970 the registration rate for lesions of all stages in this age group declined. Over the same period the 50 to 64 age group showed a tendency for an increased proportion of registrations to be of Stage I or I1 lesions. There was little change in pattern in the over‐65 age group. The possible relation of these changes to the introduction of a cervical cytology screening programme and the implications for future screening policies are discussed.

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PII: S 1 4 7 0 -0 3 2 8 ( 0 2 ) 0 1 8 4 5 -1Remote consequences of transcervical resection of the endometrium Sir,We congratulate Cooper et al. on their five-year follow up of patients following transcervical resection of the endometrium or medical treatment for menstrual problems. They conclude that transcervical resection of the endometrium 'does not lead to an increase in the number of subsequent hysterectomies' and recommend the procedure 'being offered to all eligible women seeking treatment for heavy menses' 1 . Mean age of the transcervical resection of the endometrium group was 41 years and hysterectomy rate was 19% at five years follow up, compared with 41 years and 18%, respectively, in the medically treated group.The endometrial -myometrial interface is the site of a significant nerve plexus 2 . In a small series of women undergoing transcervical resection of the endometrium, we have observed nerves in the resected chippings. Furthermore, in women with severe adenomyosis, there is denervation of large areas of the uterus. Not knowing the long term consequences of the operation, are the authors confident that the transcervical resection of the endometrium group will not require hysterectomy for adenomyosis in their remaining reproductive years? Is there any difference in their management of 35-and 45-year-old patients with excessive menstrual loss, or would they recommend endometrial resection to both? Sir, The Editor comments on the 'startling' finding that Somali women in Sweden reduce their food intake in pregnancy in order to have a smaller baby, in his remarks on the article by Essen et al. 1 in the same copy of the Journal. This finding should not be startling. Rush 2 has pointed out that in many different cultures women deliberately reduce their intake of food in order to try to ensure a smaller baby. A big baby can mean obstructed labour and perhaps death of both baby and mother. There is often truth in folklore. In obstetrics, because of high perinatal mortality in small babies and obsessions with growth retardation, we have too long assumed that bigness in babies is necessarily good.Over the last 25 years, women in Europe and America have become heavier, with increased body mass indices. Babies have also become heavier and these two factors are probably related. While there are obviously many things which have driven up the caesarean section rate, increase in baby weight may be one of them. Although this idea does not meet with universal agreement, most studies show that bigger babies mean higher caesarean section rates 3 . The best single predictor of baby weight is prepregnancy maternal weight rather than weight gain in pregnancy per se. Undoubtedly, severe caloric restriction will reduce baby weight 2 . The factors which control baby weight are many and complex but, in countries where obesity is becoming an epidemic, we should think again about this matter. It should not be surprising that where high body mass indices are bad for maternal health they may also be harmful for the baby in the...