Risk Of Ovarian Malignancy Algorithm

The Risk of Ovarian Malignancy Algorithm (ROMA) is a blood test that combines two tumour markers, CA 125 and HE4, with menopausal status to calculate a numerical risk score for ovarian malignancy. It is designed for women presenting with a pelvic mass or concerning symptoms such as persistent bloating, abdominal pain, or changes in bowel habit, where the clinician needs additional information to guide referral and further investigation. The test uses an immunoassay platform to measure both markers and applies a validated algorithm to produce a single risk percentage.

Biomarkers included

Tumour Markers
- Cancer antigen 125 (CA 125): a glycoprotein shed by ovarian epithelial cells, often elevated in ovarian cancer but also in benign conditions such as endometriosis, fibroids, and pelvic inflammatory disease.
- Human epididymis protein 4 (HE4): a protein overexpressed in ovarian cancer, particularly endometrioid and serous subtypes, with greater specificity than CA 125 in premenopausal women.

Calculated Index
- ROMA score: a validated algorithm that integrates CA 125, HE4, and menopausal status to estimate the probability of malignancy, reported as a percentage with a cut-off for low versus high risk.

Why it matters
Ovarian cancer is often diagnosed late because symptoms are vague and easily attributed to other conditions. ROMA improves the discrimination between benign and malignant pelvic masses compared with CA 125 alone, helping clinicians decide whether a woman needs urgent referral to a gynaecological oncology centre or can be managed conservatively. For premenopausal women in particular, ROMA reduces false positives that can lead to unnecessary surgery, while for postmenopausal women it supports timely escalation of care. Used alongside imaging and clinical assessment, ROMA provides a clearer, evidence-based picture of risk to inform the next step in your care.