- Genetic-test interpretation and patient counseling make up 57% of the exam - prioritize them.
- You need 71% or higher to pass; it's criterion-referenced, not curved against other candidates.
- The exam is 120 questions (100 scored, 20 unscored) in a 3-hour window.
- Register at least 2 weeks before test day; the handbook arrives within 7 days of approval.
Quick Facts Snapshot
This is the condensed, print-friendly version of everything a Cancer Genetic Risk Assessment (CGRA) candidate needs to keep straight before test day. It is not a substitute for deep content review - for that, see the full CGRA Study Guide 2026 - but it works as a final-week refresher or a quick reference you can revisit whenever a detail slips.
| Item | Detail |
|---|---|
| Governing body | National Consortium of Breast Centers, Inc. (NCBC) |
| Format | 120 multiple-choice questions (100 scored, 20 unscored) |
| Time limit | 3 hours |
| Passing score | 71% or higher, criterion-referenced |
| Initial exam fee | $495 |
| Testing modes | NCBC-administered paper/pencil or live-remote-proctored (Examity, per the linked March 2023 policy) |
| Retake wait | At least 6 months between attempts |
| Renewal | 8 education credits annually plus $150 + 3.1% processing |
Every number above traces back to the current NCBC certification pages and the linked Exam Description v2 (uploaded July 2023) - worth bookmarking directly, since policy documents occasionally get revised. If you want the story behind the numbers rather than just the numbers themselves, the CGRA Passing Score 2026 and CGRA Certification Cost 2026 breakdowns go deeper on scoring mechanics and fee structure, respectively.
Domain-by-Domain Recap
The CGRA exam blueprint has five domains. Knowing their relative weight tells you where to spend your limited study hours. For a full walkthrough of subtopics inside each domain, see the CGRA Exam Domains 2026 guide; here's the condensed version for quick review.
Domain 1: Collect and Document Pertinent Patient and Family History (15%)
Covers pedigree construction, three-generation history intake, and recognizing red-flag patterns that trigger further risk assessment.
- Standard pedigree symbols and notation conventions
- Distinguishing maternal vs. paternal lineage patterns relevant to hereditary syndromes
Domain 2: Perform Personalized Cancer Risk Assessment (18%)
Applies validated risk models and clinical criteria to estimate an individual's likelihood of carrying a hereditary cancer predisposition.
- Recognizing when a family history meets testing criteria
- Differentiating population-level risk from personalized, pedigree-based risk
Domain 3: Interpret Relevant Genetic Test Results (32%)
The single largest domain. Expect heavy coverage of variant classification, gene-specific cancer risks, and result reporting nuances.
- Pathogenic, likely pathogenic, and variant-of-uncertain-significance distinctions
- Multi-gene panel result interpretation and discordant-result scenarios
Domain 4: Determine Medical Management Options (10%)
Smallest domain but not skippable - translates genetic findings into surveillance, chemoprevention, or risk-reducing surgery discussions.
- Aligning management recommendations with established guideline bodies
- Adjusting surveillance intensity based on variant and family history
Domain 5: Effectively Communicate With and Counsel Patients (25%)
Second-largest domain. Tests informed-consent principles, psychosocial impact, and communicating uncertain or complex results clearly.
- Pre-test and post-test counseling components
- Handling variant reclassification conversations over time
Key Takeaway
Domains 3 and 5 combine for 57% of the exam. If your study time is limited, protect these two domains first and treat Domains 1, 2, and 4 as secondary - but don't ignore them, since the exam still draws scored items from all five.
If you're still deciding how much runway to give yourself, the How Hard Is the CGRA Exam? guide walks through what makes the interpretation and counseling domains feel harder than the others in practice.
Registration & Fee Mechanics
Unlike exams that let you book a seat the same week, CGRA registration has a firm lead time: applications must be submitted at least 2 weeks before your intended test date. Once NCBC approves your registration, the official handbook is emailed within 7 days - so build that window into your planning rather than assuming instant access to study materials.
- Initial exam fee: $495, covering your first sitting.
- Eligibility documentation: current unrestricted licensure as a physician, RN, APN, or PA; at least 60 relevant education/training hours within the preceding 5 years; and at least 2 years of clinical cancer-genetics/risk-assessment experience.
- Non-traditional backgrounds: other qualified professionals may request individual board review - there's no single mandatory training course required to qualify.
For the full eligibility breakdown, including how the 60-hour and 2-year requirements interact, see CGRA Requirements 2026. And if you're mapping out exactly when to submit paperwork relative to a target testing window, CGRA Exam Dates 2026 covers scheduling deadlines in more depth.
Testing Day Logistics
CGRA candidates choose between NCBC-administered paper/pencil testing or live-remote-proctored testing. The currently linked March 2023 administration policy names Examity as the remote-proctoring vendor, so if you're testing remotely, plan around that platform's technical requirements rather than assuming a generic setup will work.
Remote Testing Checklist
- Valid photo ID ready for verification
- A clear, single-monitor workspace - no secondary screens
- Working webcam, microphone, and speakers
- You must be alone in the room; no phones or headphones permitted
- No unauthorized aids of any kind during the 3-hour session
Whichever format you choose, you're working within a strict 3-hour limit across 120 multiple-choice questions - 100 scored and 20 unscored, though you won't know which is which. Pace yourself as if every question counts, since functionally, from a time-management standpoint, they do.
Scoring, Retakes & Renewal
CGRA uses a criterion-referenced passing score of 71% or higher - meaning your result is measured against a fixed standard, not ranked against other candidates in your sitting. That distinction matters: a harder question set in a given administration doesn't move the bar. For a deeper look at how this scoring model plays out and what the published pass numbers look like, see CGRA Pass Rate 2026 and CGRA Passing Score 2026.
If You Don't Pass the First Time
- You must wait at least 6 months before attempting again.
- A first retake within 12 months carries no additional exam fee.
- An attempt after a second failure costs $495 again.
Staying Certified
Renewal is annual and requires 8 cancer-genetics/risk-assessment education credits plus $150 plus 3.1% processing. Miss the deadline and your status goes inactive 60 days past expiration; decertification follows at 1 year past expiration. Mark these dates the moment you certify - they're easy to lose track of once you're back in clinical routines.
Last-Week Review Plan
If your exam is seven days out, don't restart a full study cycle - spend the week reinforcing weak spots in the highest-weighted domains. This is the one place a structured weekly approach makes sense here, and it should map directly to the CGRA blueprint rather than a generic template.
Domain 3 Deep Review
- Redo any interpretation questions you missed in practice sets
- Drill variant classification terminology until it's automatic
Domain 5 Scenario Practice
- Work through counseling-style vignettes, not just recall questions
- Review informed-consent and post-test disclosure principles
Domains 1, 2, 4 Quick Pass
- Skim pedigree notation and risk-model triggers
- Confirm management-option guideline alignment
Logistics & Rest
- Confirm testing mode, ID, and workspace setup if testing remotely
- Light review only - no new material
Timed practice matters as much as content review given the 3-hour, 120-question format. Running full-length practice sessions on the main practice test platform is one of the more efficient ways to surface which domains still need attention before the clock is real.
Who Hires CGRA-Certified Professionals
CGRA credentialing signals to employers that a clinician can competently run the full workflow - from pedigree collection through result interpretation to patient counseling - rather than just one piece of it. This tends to matter most in hereditary cancer risk clinics, breast centers, and oncology genetics programs where the same person owns intake, testing decisions, and the counseling conversation. If you're weighing whether the credential fits your career path, Is the CGRA Certification Worth It? and the CGRA Salary Guide 2026 both dig into the practical upside, and CGRA Jobs surveys the kinds of roles where this credential is explicitly listed or preferred.
Because eligibility already requires an active physician, RN, APN, or PA license plus two years of relevant clinical experience, CGRA functions as a specialization layer on top of an existing clinical career rather than an entry point into one. That's worth keeping in mind if you're exploring CGRA training options - most candidates are already practicing in cancer genetics in some capacity before they sit for the exam.
Key Takeaway
Treat this cheat sheet as a review tool, not a first-pass learning resource. Pair it with the domain guide and a timed practice test on the practice exam site to see where your actual gaps are before test day.
Frequently Asked Questions
Check your current licensure status (physician, RN, APN, or PA), tally your relevant education/training hours over the past 5 years against the 60-hour minimum, and confirm at least 2 years of clinical cancer-genetics/risk-assessment experience. See CGRA Requirements 2026 for the full detail.
Of the 120 multiple-choice questions, 100 are scored and 20 are unscored, all within a 3-hour limit. You won't be told which questions fall into which category during the exam.
Yes, but you must wait at least 6 months before attempting again. A first retake within 12 months carries no additional exam fee; an attempt after a second failure costs $495.
Status becomes inactive 60 days past expiration, and full decertification follows at 1 year past expiration. Annual renewal requires 8 cancer-genetics/risk-assessment education credits plus $150 plus 3.1% processing.
Genetic-test interpretation (32%) and patient communication/counseling (25%) together make up 57% of the exam, making them the highest-yield areas to master first.