- What CGRA Certification Is and Who Governs It
- Who Should Pursue CGRA Certification
- Eligibility Requirements
- Exam Format and the Five Content Domains
- Registration, Fees, and Testing Logistics
- Passing Score and Published Results
- Retakes and Annual Renewal
- Building a Study Plan Around the Domain Weights
- Career Paths for CGRA-Certified Professionals
- Frequently Asked Questions
- CGRA certification is administered by the National Consortium of Breast Centers (NCBC), not a generic credentialing body.
- The exam has 120 questions (100 scored, 20 unscored) with a 3-hour limit and a 71% passing score.
- Genetic-test interpretation (32%) and patient communication/counseling (25%) together make up 57% of the exam.
- Initial registration costs $495; renewal requires 8 education credits plus $150 and a 3.1% processing fee.
What CGRA Certification Is and Who Governs It
Cancer Genetic Risk Assessment (CGRA) certification recognizes clinicians who can evaluate a patient's personal and family history, interpret genetic testing, and guide medical decision-making around hereditary cancer risk. The credential is administered by the National Consortium of Breast Centers, Inc. (NCBC), an organization focused on quality standards in breast and cancer care programs. That governance detail matters: the content, exam policies, and renewal rules described on this page all come directly from NCBC's published materials, not from any other organization that happens to share the same acronym.
If you're still getting oriented to the credential itself, our companion pieces on What Is CGRA? and CGRA Meaning walk through the terminology in more depth, while What Is CGRA Certification? covers the credential's purpose in clinical practice.
Who Should Pursue CGRA Certification
CGRA certification is built for licensed clinicians who already work in or near hereditary cancer risk programs. It is not an entry-level credential - it validates experience that a candidate already has, rather than teaching that experience from scratch. Typical candidates include:
- Physicians practicing in oncology, genetics, or breast health programs
- Registered nurses and advanced-practice nurses coordinating risk-assessment clinics
- Physician assistants involved in genetic counseling referrals and follow-up care
- Other cancer-genetics professionals who may qualify through individual board review
For a deeper look at whether the time and cost commitment pays off for your career stage, see Is the CGRA Certification Worth It? Complete ROI Analysis 2026.
Eligibility Requirements
Before you can even register for the exam, NCBC requires candidates to meet three concrete prerequisites:
- Licensure: a current, unrestricted license as a physician, registered nurse, advanced-practice nurse, or physician assistant
- Education: at least 60 relevant education/training hours completed within the preceding 5 years
- Experience: at least 2 years of clinical cancer-genetics/risk-assessment experience
Notably, NCBC does not mandate any single training course to satisfy the education requirement - candidates can assemble the required hours from multiple qualifying sources. Professionals who don't fit the standard licensure categories may still be considered through an individual board review process. For the full breakdown of how these pieces fit together, read CGRA Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Key Takeaway
Start tracking your 60 education hours and 2 years of experience early - application must happen at least 2 weeks before your intended test date, and the handbook is only emailed after registration is approved.
Exam Format and the Five Content Domains
The CGRA exam is a paper/pencil or live-remote-proctored test consisting of 120 multiple-choice questions - 100 scored and 20 unscored - administered within a 3-hour limit. Because the unscored items are indistinguishable from scored ones during the test, candidates should treat every question with equal seriousness rather than trying to guess which ones "count."
Content is organized into five domains, each weighted differently. Understanding these weights is the single most important step in prioritizing your study time - a fact explored in full detail in CGRA Exam Domains 2026: Complete Guide to All 5 Content Areas.
Domain 1: Collect and Document Pertinent Patient and Family History (15%)
Covers how candidates gather, verify, and record three-generation pedigrees and personal risk factors.
- Recognizing red flags that warrant deeper family-history investigation
- Accurate pedigree notation and documentation standards
Domain 2: Perform Personalized Cancer Risk Assessment (18%)
Tests application of risk-assessment models and clinical judgment to estimate a patient's likelihood of hereditary cancer syndromes.
- Matching patient profiles to appropriate risk-assessment tools
- Integrating personal and family data into a coherent risk picture
Domain 3: Interpret Relevant Genetic Test Results (32%)
The largest domain by far, requiring fluency in variant classification, test selection, and result interpretation across hereditary cancer syndromes.
- Distinguishing pathogenic, benign, and variant-of-uncertain-significance results
- Selecting appropriate testing strategies for different clinical scenarios
Domain 4: Determine Medical Management Options (10%)
Focuses on translating genetic and risk findings into surveillance, prevention, and treatment recommendations.
- Aligning management plans with established guidelines
- Adjusting recommendations as risk factors or results change
Domain 5: Effectively Communicate With and Counsel Patients (25%)
The second-largest domain, testing a candidate's ability to explain complex genetic concepts and support informed decision-making.
- Delivering results with appropriate psychosocial sensitivity
- Addressing informed consent and shared decision-making
Registration, Fees, and Testing Logistics
The initial examination fee is $495. Registration must be submitted at least 2 weeks before your intended testing date, and once your application is approved, NCBC emails the candidate handbook within 7 days. A full cost comparison, including renewal and retake fees, is available in CGRA Certification Cost 2026: Complete Pricing Breakdown.
Candidates can sit for the exam either in person via paper/pencil administration or through live remote proctoring. The currently linked March 2023 administration policy names Examity as the remote-proctoring provider. If you choose remote testing, the requirements are strict:
- Valid photo ID for verification
- A clear, single-monitor workspace free of clutter and reference material
- Working webcam, microphone, and speakers
- Testing alone, in a private space, with no phones or headphones present
- No unauthorized aids of any kind during the session
Because exam windows and deadlines shift year to year, confirm current dates before locking in your study schedule - see CGRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling for the latest scheduling guidance.
Passing Score and Published Results
CGRA uses a criterion-referenced passing score of 71% or higher - meaning your result is measured against a fixed standard, not curved against other candidates in your testing cycle. A deep dive into how that threshold is set and what it means for your target score is available in CGRA Passing Score 2026: Exactly What You Need to Pass.
Published results give some sense of exam outcomes over time. In 2025, 20 of 23 candidates passed, a figure NCBC rounds to 87.0%. The posted 2026 results, by contrast, cover only 5 candidates with 5 passes - a small sample that does not represent a completed testing year and shouldn't be read as a stable rate. For more context on interpreting these figures responsibly, see CGRA Pass Rate 2026: What the Data Shows.
| Metric | Detail |
|---|---|
| Passing Score | 71% or higher (criterion-referenced) |
| Scored Questions | 100 of 120 total items |
| 2025 Results | 20 passed of 23 candidates (87.0%) |
| 2026 Results (partial) | 5 passed of 5 candidates |
Retakes and Annual Renewal
If you don't pass on your first attempt, NCBC requires a minimum of 6 months between attempts. The first retake within 12 months carries no additional exam fee, but if a candidate fails a second time, the next attempt costs the full $495 fee again. This structure rewards prompt, focused re-preparation rather than repeated casual attempts.
Once certified, maintaining the credential requires annual renewal: 8 cancer-genetics/risk-assessment education credits plus a $150 fee with 3.1% processing added. Missing the deadline moves a certificant into inactive status 60 days past expiration, and full decertification follows 1 year past expiration if renewal still hasn't occurred.
Key Takeaway
Treat renewal deadlines like exam deadlines - inactive status begins just 60 days after expiration, leaving little room for delay.
Building a Study Plan Around the Domain Weights
Generic study techniques only go so far with a domain-weighted exam like this one. The most effective approach is to let the percentages dictate your calendar: spend the most time where the exam spends the most points. Since Domain 3 (32%) and Domain 5 (25%) combined make up more than half the test, they deserve dedicated, sequential weeks rather than being blended in with lighter topics.
Foundations: Domains 1 & 2
- Review pedigree documentation standards and family-history red flags
- Practice applying risk-assessment models to sample case scenarios
Deep Focus: Domain 3
- Work through variant classification and result-interpretation exercises
- Compare testing strategies across hereditary cancer syndromes
Management: Domain 4
- Map genetic findings to guideline-based management options
- Practice adjusting recommendations for changing risk profiles
Communication: Domain 5
- Rehearse delivering results with appropriate sensitivity
- Review informed consent and shared decision-making scenarios
Full Review and Timed Practice
- Take full-length practice sets under the 3-hour limit
- Revisit weak domains identified during practice testing
For a structured, week-by-week walkthrough with more detail on pacing and resource selection, see CGRA Study Guide 2026: How to Pass on Your First Attempt. And once you've covered the material, a condensed CGRA Cheat Sheet 2026: One-Page Review of Must-Know Facts is useful for final review the week before your exam. Running timed practice sets on our CGRA practice test platform is one of the most reliable ways to confirm you're pacing correctly across all 120 questions.
Career Paths for CGRA-Certified Professionals
Because eligibility already requires an active clinical license and two years of hereditary-cancer-related experience, most CGRA-certified professionals are working in existing roles within breast centers, oncology practices, genetics clinics, or hospital-based risk-assessment programs. The certification functions as a formal validation layer on top of that clinical experience rather than a credential that opens an entirely new job category on its own.
If you're exploring how the credential fits into hiring and role expectations, CGRA Jobs outlines the kinds of positions where the certification is commonly listed as a preferred or required qualification, and CGRA Training covers how professionals accumulate the required education hours. For compensation context grounded strictly in what's publicly documented, see CGRA Salary Guide 2026: Complete Earnings Analysis.
Frequently Asked Questions
The National Consortium of Breast Centers, Inc. (NCBC) governs and administers the CGRA exam, either via paper/pencil testing or live-remote proctoring.
The exam has 120 multiple-choice questions - 100 scored and 20 unscored - with a 3-hour time limit.
You need 71% or higher. The passing standard is criterion-referenced, meaning it's fixed rather than adjusted relative to other candidates.
You must wait at least 6 months before retesting. The first retake within 12 months has no additional fee, but an attempt after a second failure costs $495.
Annual renewal requires 8 cancer-genetics/risk-assessment education credits plus a $150 fee with 3.1% processing added. Certificants become inactive 60 days past expiration and are decertified 1 year past expiration if not renewed.