False-negative results in screening programmes: systematic review of impact and implications


When assessing whether a screening programme is appropriate, there is a particular obligation to ensure that the harms as well as the benefits are considered. Among these harms is the likelihood that false-negative results will occur. In some cases, the consequences of these can be difficult to assess, although false reassurance leading to diagnostic delay and subsequent treatment has been suggested. However, no test is totally accurate (with 100% sensitivity and specificity), and false-negative results are inherent in any screening programme that does not have 100% sensitivity.

This review was carried out to assess the medical, psychological, economic and legal consequences of false-negative results that occur in national screening programmes.


False-negatives are evident in all screening programmes, even when the quality of the service provided is high. They may have the potential to delay the detection of breast and cervical cancer, but there is little evidence to help assess their psychological consequences in these or other screening programmes. False-negatives are likely to lead to legal action being taken by those individuals affected, and potentially may reduce public confidence in screening. Their impact may be reduced by the provision of full information to participants about the benefits and harms of screening programmes, and by increasing public education on these issues.

Conducted by: Mark P Petticrew1, Amanda J Sowden2, Deborah Lister-Sharp2, Kath Wright2

1. MRC Social and Public Health Sciences Unit, University of Glasgow; 2. NHS Centre for Reviews and Dissemination

Further details

Project page on HTA Programme website


Petticrew MP, Sowden AJ, Lister-Sharp D, Wright K. False-negative results in screening programmes: systematic review of impact and implications. Health Technol Assess. 2000;4(5):1-60

Petticrew M, Sowden AJ, Lister-Sharp D. False-negative results in screening programmes: medical, psychological, and other implications. Int J Technol Assess Health Care. 2001;17(2):164-70


Petticrew M, Sowden AJ. False negatives in screening: impact, implications, and public understanding. 17th Annual Meeting of the International Society of Technology Assessment in Health Care; 2000 June; The Hague, Netherlands


Commissioned by the HTA Programme