Understanding your health starts with access to the right information. The ROMA score — an acronym for Risk of Ovarian Malignancy Algorithm — is a clinically validated blood-based assessment that can help indicate the likelihood of ovarian malignancy in women presenting with a pelvic mass. For women in London and across the UK seeking early awareness and proactive health screening, knowing what this test involves and what its results may suggest is a valuable step in taking informed ownership of your wellbeing.
What Is the ROMA Score? A Clear Definition
The ROMA score is a calculated risk index derived from two specific blood biomarkers: CA 125 (Cancer Antigen 125) and HE4 (Human Epididymis Protein 4), combined with a woman's menopausal status. The result is expressed as a percentage, categorising a woman into either a low-risk or elevated-risk group for ovarian epithelial cancer.
> In brief: The ROMA score uses CA 125 and HE4 blood levels alongside menopausal status to generate a risk percentage. A higher score may suggest a greater likelihood of ovarian malignancy and can support clinical decision-making by appropriate healthcare professionals.
This is not a diagnostic tool in isolation, but rather a risk stratification aid — one that is increasingly used within both NHS and private healthcare settings to guide further clinical assessment.
The Biomarkers Behind the ROMA Score
CA 125 — What It May Indicate
CA 125 is a protein found in greater concentrations on the surface of ovarian cancer cells. Elevated levels can sometimes suggest ovarian malignancy, though raised CA 125 can also be associated with endometriosis, fibroids, pelvic inflammatory disease, and even menstruation. This is precisely why CA 125 is rarely used in isolation.
HE4 — The Complementary Marker
HE4 (Human Epididymis Protein 4) tends to be overexpressed in ovarian and endometrial cancers. Importantly, HE4 is less likely to be elevated in benign gynaecological conditions compared to CA 125, which makes it a more specific complementary marker. Used together, the two biomarkers provide a more nuanced risk picture.
Menopausal Status — Why It Matters
Because CA 125 and HE4 levels naturally vary across pre- and post-menopausal women, the ROMA algorithm applies different calculation formulas depending on a woman's menopausal status. This adjustment makes the final percentage more contextually meaningful.
Practical Insight: Neither CA 125 nor HE4 alone offers the same clinical value as when combined within the ROMA algorithm. The combined approach may provide a clearer indication of risk than single-marker testing.
How Is the ROMA Score Calculated?
| Component | Role in ROMA Calculation |
|---|---|
| CA 125 blood level | Primary tumour-associated antigen marker |
| HE4 blood level | Complementary, more specific ovarian marker |
| Menopausal status | Determines which formula is applied |
| ROMA algorithm | Produces a risk percentage (low or elevated) |
The calculation uses validated mathematical formulas established in clinical research. Results are expressed as a percentage, and interpreted against established cut-off values:
These thresholds are for educational reference only. Individual results must always be reviewed by an appropriate healthcare professional.
Who Should Consider a ROMA Blood Test?
The ROMA test is not a population-wide screening tool. It is most commonly considered in specific clinical contexts. Women who may wish to discuss a ROMA assessment with their healthcare provider or explore private testing include:
Practical Insight: This test is particularly relevant for women in their 40s and beyond, though it can be appropriate at any adult age where clinical context exists. Testing and results should always be discussed with a suitably qualified healthcare professional.
If you are interested in understanding more about women's cancer markers, our CA 125 cancer marker blood test page provides additional educational context.
How Often Should the ROMA Test Be Repeated?
There is no single universally recommended frequency for ROMA testing. Its use is typically guided by:
For women using private testing for health awareness purposes, discussing testing frequency with an appropriate healthcare professional is always advisable.
What Do ROMA Score Results Mean?
Understanding your ROMA result is important, but context is everything. A result alone does not confirm or exclude any condition.
Low Risk: A low ROMA score may suggest that ovarian malignancy is less likely based on current biomarker levels. This can provide reassurance, though it does not eliminate the need for clinical follow-up if symptoms persist.
Elevated Risk: An elevated ROMA score may indicate a higher statistical likelihood of ovarian epithelial cancer and typically warrants further clinical evaluation by an appropriate healthcare professional. It does not mean a diagnosis has been made.
> An elevated result is not a diagnosis. It is a signal that further clinical assessment may be warranted. Please consult an appropriate healthcare professional to interpret your results in full clinical context.
Our private blood testing services in London provide detailed written reports to support your conversation with a healthcare professional.
ROMA Testing vs. CA 125 Alone — A Comparison
| Feature | CA 125 Alone | ROMA Score (CA 125 + HE4) |
|---|---|---|
| Sensitivity for ovarian cancer | Moderate | May be higher in some clinical studies (combined approach) |
| Specificity | Lower (many false positives) | Improved with HE4 |
| Accounts for menopausal status | No | Yes |
| Recommended in clinical guidelines | Cautiously for some contexts | Recommended for risk stratification in specific clinical contexts (e.g., pelvic mass evaluation) |
| Best suited for | Initial indication | Risk stratification in pelvic mass context |
Practical Insight: ROMA is designed to offer a broader risk picture compared to CA 125 testing alone by incorporating a second biomarker and menopausal status. The combined approach may provide additional context compared to single-marker testing, though individual clinical suitability should always be assessed by a qualified healthcare professional.
Private ROMA Blood Testing in London
At Private Blood Tests London, our nurse-led clinic offers professional blood testing and result reporting services. We provide:
We provide testing and reporting only. We do not offer prescriptions, treatment, or specialist clinical consultations. All results should be discussed with a suitably qualified healthcare professional.
London's healthcare landscape offers excellent access to both NHS and private services. Private testing can support quicker access to results and give you the information you need to have a more informed conversation with your healthcare team — whether NHS or private.
You may also find our women's health blood tests and private health screening packages useful when considering broader gynaecological health awareness.
Frequently Asked Questions — ROMA Score and Ovarian Cancer Risk
1. What is the ROMA score and how does it work?
The ROMA score (Risk of Ovarian Malignancy Algorithm) is a clinically validated risk index calculated using CA 125 and HE4 blood biomarker levels, combined with a woman's menopausal status. The result is expressed as a percentage indicating whether a woman falls into a low-risk or elevated-risk category for ovarian epithelial cancer. It is a risk stratification tool, not a standalone diagnostic test.
2. Is the ROMA score the same as a diagnosis of ovarian cancer?
No. The ROMA score is not a diagnostic test. An elevated result may suggest a higher statistical likelihood of ovarian malignancy, but it does not confirm cancer. Equally, a low ROMA score does not completely exclude malignancy. Any result should be discussed with an appropriate healthcare professional for proper clinical interpretation.
3. What does an elevated ROMA score mean?
An elevated ROMA score may indicate that further clinical evaluation is advisable. It suggests the biomarker levels and menopausal status, taken together, place a woman in a statistically higher-risk group. This warrants discussion with a healthcare professional who can recommend appropriate next steps. It is not cause for alarm in isolation.
4. Can the ROMA test be done privately in London?
Yes. Private ROMA blood testing is available in London through nurse-led clinics such as Private Blood Tests London. We provide professional blood testing and written result reports. Results should always be reviewed with a suitably qualified healthcare professional, as we provide testing and reporting services only.
5. Is HE4 a better marker than CA 125 for ovarian cancer risk?
Both markers have different strengths. HE4 tends to be more specific to ovarian malignancy and is less likely to be elevated by benign conditions. CA 125, while widely used, can be elevated in non-cancerous conditions such as endometriosis. Together, within the ROMA algorithm, they provide a more meaningful combined risk picture than either marker alone.
6. Who is the ROMA test most appropriate for?
The ROMA test is most commonly considered for women with a known pelvic mass, persistent unexplained gynaecological symptoms, a family history of ovarian or breast cancer, or previously elevated CA 125 readings. It may also be relevant for women seeking proactive health awareness. Individual suitability should be discussed with a healthcare professional.
7. How long does it take to receive ROMA test results?
At Private Blood Tests London, we aim to provide prompt written results following sample collection. Turnaround times may vary, so we recommend checking directly with our clinic. Results are provided in a written report format to support your discussion with a healthcare professional.
8. Does the ROMA score change over time?
Yes. Biomarker levels such as CA 125 and HE4 can change over time due to hormonal shifts, menopausal status changes, or underlying health changes. This is why serial testing — where clinically indicated — may provide more useful trending information than a single result in isolation.
9. Is the ROMA test available on the NHS?
The ROMA test or its component markers (CA 125 and HE4) may be used within NHS gynaecological services in specific clinical contexts. However, access through the NHS is typically tied to referral pathways. Private testing offers an option for women who wish to access this assessment more promptly or without a GP referral.
10. What should I do if my ROMA score is elevated?
If your ROMA score returns an elevated result, the most important step is to seek guidance from an appropriate healthcare professional — such as a gynaecologist or your GP — who can contextualise the result alongside your symptoms, medical history, and any additional assessments that may be recommended. Do not delay seeking professional advice.
A Note on Our Approach
At Private Blood Tests London, our nurse-led team is committed to providing accurate, professional blood testing and clear written reporting. We believe that access to reliable health information supports better conversations between patients and healthcare professionals. Our service is focused entirely on testing and result reporting. We do not offer prescriptions, clinical diagnoses, specialist consultations, or treatment services.
For women seeking proactive health awareness, our private blood tests in London provide a professional, accessible pathway to the biomarker information that matters to you.
Taking a Proactive Step for Your Wellbeing
Understanding your health markers is one of the most empowering things you can do. Whether you're exploring the ROMA score out of curiosity, following up on previous results, or simply taking a more informed approach to your gynaecological health, private blood testing in London offers a professional and accessible route.
If you'd like to explore ROMA testing or any of our other women's health blood panels, we warmly invite you to get in touch with our clinic. We're here to support your health awareness journey — professionally, clearly, and without pressure.
> Educational Disclaimer
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> This article has been written for educational and informational purposes only. It does not constitute medical advice, a clinical diagnosis, or a recommendation for any specific treatment or healthcare pathway. The content is intended to support general health awareness and should not be used as a substitute for professional medical advice.
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> Individual health concerns, symptoms, or test results should always be assessed by a suitably qualified healthcare professional who can consider your full medical history and clinical context. If you are experiencing symptoms that concern you, please seek appropriate medical care promptly.
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> Private Blood Tests London provides blood testing and written reporting services only. We do not offer prescriptions, clinical diagnoses, specialist consultations, or treatment services. All results should be reviewed with an appropriate healthcare professional.
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> This content has been produced in line with GMC advertising guidance, CQC patient communication standards, and ASA guidelines for health-related content.
Written Date: 12 August 2026 Next Review Date: 12 August 2027