- CGRA stands for Cancer Genetic Risk Assessment, a credential administered by the National Consortium of Breast Centers (NCBC).
- The exam is 120 multiple-choice questions (100 scored, 20 unscored) with a 3-hour limit.
- Passing requires 71% or higher on a criterion-referenced scale - not a curve.
- Genetic-test interpretation (32%) and patient communication/counseling (25%) together make up 57% of the exam.
What CGRA Means
CGRA stands for Cancer Genetic Risk Assessment. It is a professional certification for licensed clinicians who evaluate patients' personal and family cancer history, order or interpret genetic testing, and counsel patients on hereditary cancer risk. The credential is issued by the National Consortium of Breast Centers, Inc. (NCBC), and it exists specifically to validate competency in the clinical workflow that runs from collecting a family history to explaining a genetic test result to a patient sitting across the exam table.
Because the letters "CGRA" appear attached to more than one professional designation across different industries, it's worth being precise: on this site, and throughout this article, CGRA refers only to Cancer Genetic Risk Assessment as defined and administered by the NCBC. No fact in this article is borrowed from any other credential that happens to share the same initials.
Who Uses the Term "CGRA"
The term shows up most often in three settings:
- Hereditary cancer risk clinics - where staff review pedigrees, order panel testing, and counsel patients on options like enhanced screening or risk-reducing surgery.
- Breast center and oncology program job postings - where "CGRA-certified" or "CGRA-eligible" signals that a candidate can independently manage the genetic-risk portion of patient care.
- Continuing-education and credentialing literature - where CGRA is listed alongside other cancer-specific certifications as evidence of specialized, ongoing competency.
If you're researching the term because you saw it in a job listing or heard a colleague mention it, our companion piece What Is CGRA? walks through the full context of the role, and CGRA Jobs looks at how employers actually use the credential when hiring.
The Credential Behind the Acronym
Once you know what the letters stand for, the more useful question is: what does the credential actually certify? The NCBC built the CGRA exam around a defined body of knowledge, not a vague sense of "genetics experience." Candidates who pass have demonstrated they can move a real patient through the full risk-assessment process - not just recite genetics vocabulary.
The current exam is built on CGRA Exam Description v2, uploaded in July 2023, which is the version currently referenced by NCBC's own documentation. That document is the authoritative source for the domain breakdown covered below, and it's worth reading directly if you want the primary-source language rather than a summary.
For a deeper breakdown of what the name actually implies about scope and clinical focus, see What Does CGRA Mean? and What Does CGRA Stand For? - both cover adjacent angles on the same underlying credential.
The Five Domains CGRA Covers
The exam content is organized into five domains, each weighted differently. Understanding these weights matters more than most candidates initially assume - they tell you exactly where your study hours should go.
Domain 1: Collect and Document Pertinent Patient and Family History (15%)
Covers pedigree construction, identifying red-flag family history patterns, and documenting information accurately enough to support later risk calculations.
- Three-generation pedigree standards
- Recognizing patterns suggestive of hereditary syndromes
Domain 2: Perform Personalized Cancer Risk Assessment (18%)
Focuses on applying risk models and clinical criteria to determine a patient's likelihood of carrying a hereditary cancer syndrome.
- Risk-model selection and appropriate use
- Distinguishing sporadic from hereditary risk patterns
Domain 3: Interpret Relevant Genetic Test Results (32%)
The largest domain by far, and the one that most differentiates CGRA from general oncology knowledge.
- Variant classification (pathogenic, benign, VUS)
- Panel testing result interpretation across multiple genes
Domain 4: Determine Medical Management Options (10%)
Translates a risk assessment or test result into concrete management recommendations.
- Screening and surveillance protocol selection
- Risk-reducing intervention options
Domain 5: Effectively Communicate With and Counsel Patients (25%)
Tests the clinician's ability to translate technical results into language patients and families can act on.
- Explaining uncertain results (VUS) without causing unnecessary alarm
- Psychosocial and family-communication considerations
Key Takeaway
Domains 3 and 5 together account for 57% of the exam. If your study time isn't weighted toward genetic-test interpretation and patient counseling, you're studying against the wrong target. For a full domain-by-domain breakdown, see CGRA Exam Domains 2026: Complete Guide to All 5 Content Areas.
Exam Format and Mechanics
The CGRA exam is a 3-hour, 120-question multiple-choice test: 100 items are scored and 20 are unscored (used for future item development, though candidates don't know which is which during the exam). It is administered by NCBC either as a paper/pencil exam or as a live-remote-proctored exam; the currently linked administration policy names Examity as the remote-proctoring provider.
Remote candidates need a clear single-monitor workspace, a webcam, a microphone, and speakers, and must test alone with no phones or headphones in the room. Photo ID verification is required, and unauthorized aids are prohibited - standard proctoring rules, but ones that catch unprepared candidates off guard if they haven't set up their space in advance.
Passing requires a score of 71% or higher. This is a criterion-referenced cut score, meaning it is not adjusted or curved based on how other candidates perform in a given administration. For the full mechanics of how that score is set and what it means for your preparation, see CGRA Passing Score 2026: Exactly What You Need to Pass.
| Exam Attribute | Detail |
|---|---|
| Total questions | 120 (100 scored, 20 unscored) |
| Time limit | 3 hours |
| Passing score | 71% or higher, criterion-referenced |
| Delivery formats | Paper/pencil or live-remote-proctored |
| Initial fee | $495 |
If you're trying to gauge how tough this actually is relative to your background, How Hard Is the CGRA Exam? Complete Difficulty Guide 2026 breaks down the difficulty by domain, and CGRA Pass Rate 2026: What the Data Shows covers the published outcome data directly from NCBC.
Who Can Sit for the CGRA Exam
CGRA eligibility is built around active clinical licensure plus documented experience - it is not open to anyone with a general interest in genetics. Candidates must hold one of the following:
- Current unrestricted physician licensure
- Current unrestricted registered-nurse licensure
- Current unrestricted advanced-practice-nurse licensure
- Current unrestricted physician-assistant licensure
On top of licensure, candidates need at least 60 relevant education/training hours completed in the preceding five years, plus at least 2 years of clinical cancer-genetics/risk-assessment experience. NCBC does not mandate any single training course to satisfy the education requirement, which gives candidates flexibility but also means they need to track their own hours carefully. Other qualified professionals outside the four listed licensure categories may request an individual board review.
The full eligibility checklist, including how to document your hours and experience, is covered in CGRA Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Fees, Registration, and Renewal
Application and registration must be completed at least two weeks before the intended test date, and once registration is approved, the candidate handbook is emailed within seven days. The initial exam fee is $495.
Retake rules are structured to give candidates a reasonable second chance without penalizing a single miss too heavily: at least six months must pass between attempts, and the first retake within 12 months carries no additional exam fee. If a candidate fails a second time, the next attempt costs the full $495 again.
Certification isn't a one-time event - it requires ongoing maintenance. Annual renewal calls for 8 cancer-genetics/risk-assessment education credits plus a $150 fee with 3.1% processing added. Missing the deadline moves a certificant to inactive status 60 days past expiration, and full decertification follows one year past expiration if nothing is resolved.
For the complete cost picture - initial fee, renewal fee, retake scenarios, and what the processing charge adds up to - see CGRA Certification Cost 2026: Complete Pricing Breakdown and the scheduling specifics in CGRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Mapping Study Time to Meaning
Understanding what CGRA stands for is the easy part. Turning that understanding into a passing score means allocating study time in proportion to domain weight, not in proportion to how comfortable a topic feels. Genetic-test interpretation at 32% and patient counseling at 25% should consume more than half your prep time combined - yet many candidates default to spending equal time across all five domains simply because that feels balanced.
Domain 3 Foundation
- Build fluency in variant classification terminology
- Work through panel-result interpretation scenarios
Domain 5 Communication Skills
- Practice explaining VUS results in plain language
- Review family-communication and psychosocial considerations
Domains 1, 2, and 4
- Pedigree standards and risk-model application
- Management option selection by syndrome
Full Review and Timed Practice
- Simulate the 3-hour, 120-question format
- Identify weak domains from missed-question patterns
A more detailed, week-by-week plan with resource recommendations is available in CGRA Study Guide 2026: How to Pass on Your First Attempt, and if you want a condensed, one-page reference for last-minute review, the CGRA Cheat Sheet 2026: One-Page Review of Must-Know Facts is built for exactly that purpose. Running full-length timed drills on our practice test platform is one of the more reliable ways to confirm your domain weightings actually match your real performance before exam day.
Beyond the Acronym: Career Context
Knowing that CGRA means Cancer Genetic Risk Assessment matters most when you connect it to how employers actually use the credential. Breast centers, oncology programs, and genetic counseling teams reference CGRA certification specifically because it verifies a defined, tested skill set across all five domains - not general familiarity with genetics. If you're weighing whether pursuing the credential fits your career path, Is the CGRA Certification Worth It? Complete ROI Analysis 2026 and CGRA Salary Guide 2026: Complete Earnings Analysis address that question directly, while CGRA Training covers preparation options beyond self-study. For a broader overview of the certification itself, CGRA Certification and What Is A CGRA? are useful starting points, and testing your readiness with realistic questions on our CGRA practice exams is a practical next step once you understand the terminology.
Frequently Asked Questions
CGRA stands for Cancer Genetic Risk Assessment, a certification administered by the National Consortium of Breast Centers (NCBC) for licensed clinicians working in hereditary cancer risk programs.
It's a certification, not a license. Candidates must already hold an unrestricted license as a physician, RN, APN, or PA before they're eligible to sit for the CGRA exam.
The exam contains 120 multiple-choice questions - 100 scored and 20 unscored - administered within a 3-hour time limit.
You need 71% or higher. The score is criterion-referenced, meaning it's a fixed standard rather than one that shifts based on other candidates' performance.
Genetic-test interpretation (32%) and patient communication/counseling (25%) together make up 57% of the exam, making them the two highest-priority domains for study time.