ROCA test NHS14 Apr 2026 10:27
Posted on 25th March 2026. Good piece on ROCA test from Genincode being used at UCL NHS. Hopefully rolled out nationwide soon.
Adam Rosenthal FRCOG PhD
Consultant gynaecologist, University College London Hospitals NHS Foundation Trust, and professor of gynaecological cancer prevention at University College London, UK
https://hospitalhealthcare.com/clinical/oncology/high-risk-ovarian-cancer-surveillance-vs-surgery-insights-into-roca-testing/
ROCA testing for ovarian cancer
The Risk of Ovarian Cancer Algorithm (ROCA) test involves collecting a blood sample every four months to measure serum cancer antigen 125 (CA125) using a specialised assay and a high-quality analyser to minimise intra-assay variation. The algorithm takes into consideration the woman’s age, high-risk status and menopausal status.
Once more than two longitudinal samples have been taken, the algorithm can assess the natural variation around a woman’s individual CA125 baseline and determine whether the next sample’s result falls within that range. It then calculates the risk of the women currently having ovarian cancer, based on all the above factors.
The risk score is expressed as a ratio. Ratios greater than 1:1000 are considered normal and any result worse than that triggers intervention. This means a repeat ROCA test at six weeks (risk 1:500–1:1000), a repeat test at six weeks with a transvaginal ultrasound scan (1:499–1:34) or direct referral to a gynaecology rapid access clinic with a transvaginal ultrasound scan (<1:34).
Trial results in the UK1,2 and US3 using the ROCA test in high-risk populations showed remarkably consistent results. Incident cancers in BRCA-carriers were downstaged, with around half diagnosed at stage 1 or 2, rather than nearly all at stage 3.
This earlier diagnosis resulted in clinical benefits, including less extensive surgery, which reduces morbidity and length of inpatient stay, reduced need for neo-adjuvant chemotherapy to shrink otherwise inoperable tumours, and a very high rate (>90%) of complete cytoreduction at primary surgery – that is, no visible tumour remaining at the end of the operation.
Although the data were non-randomised, so a survival advantage could not be claimed, the above outcomes are strong prognostic indicators. It is therefore reasonable to expect better outcomes when cancers are detected earlier through surveillance.
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