Objectives Though highly effective, the vaccine against the human papillomavirus (HPV) does not completely eradicate the risk of cervical dysplasia and subsequent malignancy.

Methods We present a case series of patients treated between 2007- 2017 for cervical dysplasia or invasive carcinoma after immunization with at least 2 doses of the quadrivalent HPV vaccine. Demographic and clinicopathologic data were collected and descriptive statistics were used.

Results Thirty-five patients were identified. Median age was 21.0 years(range, 13–30)at diagnosis and 27.8years (range, 18.2–36.1)at completion of HPV vaccination. Median follow-up was 17.1 months. Three doses were administered in 22 patients (62.9%). Fifteen patients (42.9%) had cervical dysplasia and 20 (57.1%) had invasive carcinoma. Squamous histology was present in 18 cases (51.4%) and adenocarcinoma in 17 cases (48.6%). All patients with invasive carcinoma had stage I disease while 10 (50%) had lymphovascular space invasion. Thirty patients (85.7%) had fertility-sparing surgery and 32 (91.4%) were treated with surgery alone. At the time of last follow-up, 32 patients (91.4%) had no evidence of disease, 2 had persistent HPV infection and 1 had recurrence carcinoma treated with pelvic exenteration.

Conclusions Cervical dysplasia and malignancy after HPV vaccination can occur, and a majority of cases are HPV associated, suggesting incomplete coverage of the vaccine or vaccination after HPV exposure. In our series, all vaccinations occurred after the CDC recommended age of 11–12 years old, which highlights the need to complete vaccination prior to HPV exposure, in addition to continued screening for cervical cancer per guidelines.