What is a ROMA Score for Ovarian Cancer?

The Risk of Ovarian Malignancy Algorithm (ROMA) is a tool doctors use to estimate the likelihood that an ovarian cyst or pelvic mass is a specific type of cancer called epithelial ovarian cancer ^[1][2].

Important Note: The ROMA score is not a general screening test for women without symptoms. It is only used for patients who have already been diagnosed with a pelvic mass or ovarian cyst ^[1].

When you have a pelvic mass, your doctor needs to decide if it is likely to be benign (non-cancerous) or malignant (cancerous). The ROMA score helps with this by combining the results of two blood tests—CA-125 and HE4—along with whether or not you have gone through menopause ^[3][4]. The calculation produces a final percentage score that categorizes your risk of cancer as either “high risk” or “low risk” ^[5][6].

How the ROMA Score is Calculated

The ROMA score is not a single lab test, but a mathematical formula that combines three pieces of information:

• CA-125: This is a protein in the blood that is often elevated in women with ovarian cancer. However, it can also go up for many non-cancerous reasons, like menstruation, fibroids, or pelvic infections.
• HE4 (Human Epididymis Protein 4): This is another protein often elevated in ovarian cancer. HE4 is particularly helpful because it is less likely than CA-125 to be affected by common benign conditions like endometriosis (a condition where tissue similar to the lining of the uterus grows outside it) ^[4][7].
• Menopausal Status: Because the baseline levels of these proteins naturally change as you age and go through menopause, the ROMA calculation uses different math and different risk thresholds for premenopausal (before menopause) and postmenopausal (after menopause) women to make the score as accurate as possible ^[5][6].

How to Prepare for the Test

Getting a ROMA score requires a simple blood draw. You generally do not need to fast beforehand. However, because menstruation can temporarily elevate CA-125 levels, your doctor may suggest avoiding the blood test during your period if scheduling allows.

What Your Results Mean

Because different laboratories use different equipment, the exact percentage that makes a score “high risk” can vary slightly. Always check the reference range on your specific lab report. However, standard cutoffs used by many labs are:

• Premenopausal Women: A score of 11.4% or higher is typically considered high risk.
• Postmenopausal Women: A score of 29.9% or higher is typically considered high risk.

By evaluating all three factors together, the ROMA score is generally more accurate than checking CA-125 alone ^[1]. Once calculated, your score will fall into one of two categories:

• High Risk: A high-risk score means there is a greater statistical chance the mass is cancerous. It is not a definitive diagnosis of cancer, but it usually means your doctor will strongly recommend you see a gynecologic oncologist (a surgeon who specializes in female reproductive cancers) for further evaluation and surgical planning ^[8][9]. Research shows that having a gynecologic oncologist perform the surgery greatly improves outcomes if cancer is found.
• Low Risk: A low-risk score means there is a lower chance of the mass being epithelial ovarian cancer ^[1]. Depending on your imaging results and symptoms, your doctor may recommend safely monitoring the cyst over time, or a general gynecologist may be able to perform the surgery to remove it. However, a low score does not guarantee the mass is completely benign ^[10].

Important Limitations to Keep in Mind

While the ROMA score is a helpful tool, it is not perfect. It is important to know its limitations:

• It targets one specific cancer type: ROMA is designed specifically to detect epithelial ovarian cancer, which is the most common type. It is not as effective for detecting rarer types of ovarian tumors, such as germ cell or sex-cord stromal tumors ^[11][12].
• It can miss early-stage disease: Like many blood tests, it can sometimes miss early-stage (Stage I) cancers or borderline tumors (tumors with abnormal cells that are not true cancer and have a very low potential to spread) ^[13][10].
• It is never used alone: A ROMA score cannot diagnose cancer by itself. Your care team will always use it alongside a physical exam, your medical history, and imaging like a pelvic ultrasound or MRI.