The entrance exams to Japanese universities have long been criticised for creating negative “washback” on English education in high schools in Japan, as teachers have often focused their teaching efforts on teaching grammar to prepare students for these exams rather than helping students to develop competency in spoken English. Many government initiatives have attempted to reform English language education by encouraging a greater focus on speaking competency. This paper outlines the nature of the Japanese university entrance exam system, considers the phenomenon of washback, and critically reviews the body of empirical research related to washback in the Japanese context. A systematic review was conducted on articles published between 1993 and June, 2022. These articles were subjected to thematic analysis in which four broad categories were identified: learner behaviour; washback to teacher behaviour; affective factors; and washback specifically from the introduction of the listening test. Findings suggest that more empirical studies are required to understand the complex nature of washback from university entrance exams, and that future research is required to examine potential washback from four-skills testing and, in particular, from the inclusion of a speaking test.