Understanding HE4 and the ROMA Score: A Clinical Guide

The Role of HE4 and the ROMA Score in Ovarian Cancer Risk Assessment

When you are facing a medical diagnosis, you often hear many acronyms. Two terms that are increasingly part of the conversation around ovarian cancer risk are HE4 and the ROMA score.

If your physician has mentioned these tests, it is likely because they are trying to gain a clearer picture of an adnexal mass—a growth on or near the ovary—found during an exam or imaging scan.

What is HE4?

HE4 (Human Epididymis Protein 4) is a protein that is often overproduced by ovarian cancer cells, specifically epithelial ovarian cancers.

While the CA-125 test has traditionally been used to monitor ovarian conditions, it can sometimes be elevated for reasons other than cancer, such as endometriosis, fibroids, or other inflammatory gynecologic conditions. HE4 is often more specific to ovarian cancer, which helps clinicians differentiate between benign (non-cancerous) growths and potential malignancies.

What is the ROMA Score?

ROMA stands for Risk of Ovarian Malignancy Algorithm. It is not a test in itself, but rather a calculation that combines three key pieces of information to estimate the risk that an ovarian mass might be malignant:

1. 1. HE4 levels
2. 2. CA-125 levels
3. 3. Menopausal status (your age and whether you have gone through menopause)

By looking at all three factors together, the ROMA score provides a more nuanced risk assessment than a single protein test could.

When are these tests used?

It is vital to understand that HE4 and ROMA are not general screening tests for the public. They are diagnostic tools for a specific clinical situation. They are most commonly used in women who: Have already been identified as having an adnexal mass. Are currently scheduled for surgery to investigate that mass. * Have not yet received a referral to a gynecologic oncologist.

The goal of using the ROMA score is to help your healthcare team decide if you should be referred to a gynecologic oncologist—a surgeon with specialized training in cancers of the reproductive system—to ensure you receive the most precise and appropriate care.

Interpretation and Next Steps

The ROMA score classifies a patient into a "high risk" or "low risk" category, but these results are never meant to stand alone. They must be interpreted by your doctor alongside: Clinical history and physical examination. Imaging results (such as transvaginal ultrasound or pelvic MRI). * Other established risk scoring systems.

A low ROMA score does not rule out cancer, and a high score does not confirm it. These tools are designed to facilitate better communication between your primary care provider and a specialist, helping to ensure that if there is a concern, you are in the right hands as quickly as possible.

***

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Please consult with your gynecologic oncologist or primary care provider regarding your specific test results and treatment plan.