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

Area of Science:

• Public Health
• Medical Screening
• Health Services Research

Background:

• Screening programmes must balance benefits against harms, including false-negative results.
• False-negatives can lead to diagnostic delays and false reassurance.
• No screening test is 100% accurate; false-negatives are an inherent limitation.

Purpose of the Study:

• To determine the consequences of false-negative findings in national screening programmes.
• To investigate methods for minimizing adverse effects of false-negatives.
• To assess implications for the National Health Service (NHS) and public confidence.

Main Methods:

• Systematic literature review of 18 electronic databases, bibliographies, and expert contacts.
• Outcomes assessed included medical, psychological, economic, and legal consequences.
• Included analysis of impact on public confidence in screening programmes.

Main Results:

• Limited quantitative data on medical and psychological consequences; anecdotal evidence prevalent.
• One study linked false-negatives in antenatal screening to lower parental acceptance.
• Evidence suggests significant legal impact (e.g., cervical screening litigation) and potential negative impact on public confidence, though evidence is limited.

Conclusions:

• False-negatives occur even in high-quality screening programmes.
• Potential for delayed cancer detection (breast, cervical); psychological consequences poorly understood.
• False-negatives are likely to result in legal action and may reduce public confidence in screening.