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Here we present the first\u2014to our knowledge\u2014evaluation of the impact of the 4vHPV vaccination in real life without selection bias in the reported data. The study has been carried out by comparing the results after first cervical screening between an HPV\u2010vaccinated and an unvaccinated birth cohort, consisting of women born in Denmark in 1993 and 1983, respectively. Cytology data covering an 8\u2010year period, from the age of 15 (age of HPV\u2010vaccination) to age 23 (age of invitation to first cervical screening), were retrieved from the Danish National Pathology Register. Abnormal cytology, defined as atypical squamous cell of undetermined significance and worse (ASCUS+) was detected in 9.4% of women born in 1993 as compared with 9.0% of women born in 1983; RR\u2009=\u20091.04 (95% CI 0.96\u20131.12), <jats:italic>p<\/jats:italic>\u2009=\u2009.29. Detection of high\u2010grade squamous intraepithelial lesion (HSIL) was statistically significantly lower in the 1993 than in the 1983 cohort, RR\u2009=\u20090.6 (95% CI 0.5\u20130.7), <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001, while the opposite pattern was seen for ASCUS RR\u2009=\u20091.4 (95% CI 1.2\u20131.6), <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001. The decrease in HSIL means that more women can be spared referral for colposcopy and biopsy. The increase of ASCUS could be explained by transition from conventional to liquid\u2010based cytology, but this observation requires further monitoring.<\/jats:p>","DOI":"10.1002\/ijc.31568","type":"journal-article","created":{"date-parts":[[2018,4,30]],"date-time":"2018-04-30T02:52:31Z","timestamp":1525056751000},"page":"1662-1670","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Impact of HPV vaccination on outcome of cervical cytology screening in Denmark\u2014A register\u2010based cohort study"],"prefix":"10.1002","volume":"143","author":[{"given":"Lise Holst","family":"Thamsborg","sequence":"first","affiliation":[{"name":"Department of Public Health University of Copenhagen Copenhagen 1014 Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1197-2599","authenticated-orcid":false,"given":"George","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Department of Public Health University of Copenhagen Copenhagen 1014 Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise Grupe","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Pathology Zealand University Hospital Roskilde 4000 Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsebeth","family":"Lynge","sequence":"additional","affiliation":[{"name":"Nyk\u00f8bing Falster Hospital University of Copenhagen Ejegodvej 63 DK\u20104800 Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa061760"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa061741"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2011.11.097"},{"key":"e_1_2_10_5_1","unstructured":"AndersenPH.Statens Serum Institut; EPI\u2010NEWS No. 49 2015.https:\/\/www.ssi.dk\/English\/News\/EPI-NEWS\/2015\/No%2049%20-%202015.aspx"},{"key":"e_1_2_10_6_1","unstructured":"State Serum Institute Vaccine coverage (In Danish).https:\/\/www.ssi.dk\/Smitteberedskab\/Sygdomsovervaagning\/VaccinationSurveillance. aspx?xaxis=Cohort&vaccination =5& sex=0&landsdel=100&show=&datatype= Vaccination&extendedfilters =True#HeaderText[Accessed 9 November2017]"},{"key":"e_1_2_10_7_1","unstructured":"Screening for livmoderhalskr\u00e6ft \u2013 anbefalinger 2012. 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