- What CGRA Actually Stands For
- Who Administers the CGRA Credential
- CGRA Exam Format and Structure
- The 5 CGRA Domains Explained
- Who Pursues CGRA Certification
- Eligibility and Prerequisites
- Registration, Fees, and Testing Logistics
- Maintaining the Credential
- Mapping Study Time to Domain Weight
- Frequently Asked Questions
- 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 and a 71% passing score.
- Genetic-test interpretation (32%) and patient communication/counseling (25%) together make up 57% of the exam.
- Eligibility requires active licensure (MD, RN, APRN, or PA), 60 relevant education hours in 5 years, and 2 years of clinical cancer-genetics experience.
What CGRA Actually Stands For
CGRA stands for Cancer Genetic Risk Assessment. It is a specialty certification for clinicians who evaluate patients' hereditary cancer risk, interpret genetic test results, and guide medical management decisions based on family history and genetic findings. If you landed here searching for what the acronym means in a healthcare credentialing context, this is the definition that matters: a clinical, patient-facing designation focused on cancer genetics, not a general research or administrative title.
Because the letters "CGRA" appear attached to more than one credential across different industries, it's worth being precise. On this site, and throughout CGRA Certification resources, CGRA refers exclusively to the cancer-genetics credential described below. If you're still building foundational understanding, our companion pieces What Is CGRA?, CGRA Meaning, and What Does CGRA Stand For? cover the same core definition from slightly different angles.
Who Administers the CGRA Credential
The CGRA credential is administered by the National Consortium of Breast Centers, Inc. (NCBC). NCBC oversees the exam content, eligibility review, scoring policy, and renewal requirements. Because NCBC is a specialty organization rooted in breast center accreditation and multidisciplinary cancer care, the CGRA exam reflects real clinical workflows found in breast centers, genetics clinics, and oncology programs rather than abstract theory.
Testing itself is delivered by NCBC through paper/pencil administration or live-remote proctoring. The remote-proctoring policy currently linked from NCBC's site names Examity as the proctoring vendor, though candidates should always confirm current logistics directly with NCBC before scheduling, since proctoring vendors and policies can be updated between administrations.
CGRA Exam Format and Structure
The CGRA exam is built around a straightforward but demanding format:
- 120 multiple-choice questions total - 100 scored items and 20 unscored (pretest) items, indistinguishable from each other during the exam
- 3-hour time limit for the full exam
- Passing score of 71% or higher, applied as a criterion-referenced standard rather than a curve relative to other candidates
- Initial examination fee of $495
Because passing is criterion-referenced, your score is measured against a fixed content standard set by NCBC's exam committee - not against how other candidates performed in your testing window. That distinction matters when you're evaluating your own readiness; there's no "beating the curve," only mastering the tested content. For a deeper breakdown of what a 71% actually requires in practice, see CGRA Passing Score 2026: Exactly What You Need to Pass.
The current exam blueprint is documented in NCBC's CGRA Exam Description v2, uploaded July 2023. That document is the authoritative source for content weighting, and it's worth reviewing directly rather than relying solely on secondhand summaries.
Key Takeaway
120 questions, 3 hours, 71% to pass, criterion-referenced. There is no partial credit for guessing strategy substituting for actual domain knowledge - the content weighting below tells you exactly where to focus.
The 5 CGRA Domains Explained
NCBC organizes CGRA content into five domains, each with a fixed weight on the exam. Understanding these weights is the single most important planning tool a candidate has, because two domains together account for more than half the exam.
Domain 1: Collect and Document Pertinent Patient and Family History (15%)
Covers pedigree construction, red-flag family history patterns, and accurate documentation practices that feed into risk models.
- Recognizing hereditary cancer syndrome patterns across generations
- Standard pedigree notation and documentation conventions
Domain 2: Perform Personalized Cancer Risk Assessment (18%)
Tests application of risk assessment models and integration of clinical, family, and demographic factors into a personalized risk estimate.
- Selecting appropriate risk models for a given clinical scenario
- Interpreting quantitative risk outputs correctly
Domain 3: Interpret Relevant Genetic Test Results (32%)
The single largest domain on the exam. Covers variant classification, test selection, and correct interpretation of results ranging from pathogenic findings to variants of uncertain significance.
- Distinguishing pathogenic, likely pathogenic, VUS, and benign classifications
- Understanding test scope and its limits (panel vs. single-gene, etc.)
Domain 4: Determine Medical Management Options (10%)
Covers translating genetic and risk findings into surveillance, chemoprevention, or surgical management recommendations.
- Matching management guidelines to specific mutation findings
- Understanding surveillance intervals tied to risk category
Domain 5: Effectively Communicate With and Counsel Patients (25%)
The second-largest domain. Covers pre- and post-test counseling, informed consent, and communicating uncertainty or difficult results.
- Structuring pre-test counseling and informed consent conversations
- Delivering and contextualizing results, including uncertain findings
Together, Domain 3 (32%) and Domain 5 (25%) make up 57% of the entire exam. That single fact should shape how you allocate study time - a candidate who masters history-taking and risk models but under-prepares on test interpretation and counseling communication is optimizing for the smaller half of the exam. For the full breakdown of each domain's subtopics and sample question styles, see CGRA Exam Domains 2026: Complete Guide to All 5 Content Areas.
| Domain | Weight |
|---|---|
| Domain 3: Interpret Genetic Test Results | 32% |
| Domain 5: Patient Communication/Counseling | 25% |
| Domain 2: Personalized Cancer Risk Assessment | 18% |
| Domain 1: Patient/Family History Collection | 15% |
| Domain 4: Medical Management Options | 10% |
Who Pursues CGRA Certification
CGRA candidates are practicing clinicians already working in or moving into cancer genetics roles: nurses and advanced-practice nurses in genetics clinics, physician assistants supporting oncology or breast center teams, and physicians who manage hereditary cancer risk as part of their practice. The credential signals to employers - breast centers, cancer genetics programs, oncology practices, and hospital systems with genetics services - that a clinician has demonstrated competency across the full risk-assessment workflow, not just one piece of it.
If you're evaluating whether this credential fits your career trajectory, our guides on CGRA Jobs and CGRA Salary Guide 2026: Complete Earnings Analysis go deeper into hiring patterns and compensation considerations, while Is the CGRA Certification Worth It? Complete ROI Analysis 2026 weighs the investment against the credential's practical career value.
Eligibility and Prerequisites
NCBC requires candidates to meet several concrete prerequisites before sitting for the CGRA exam:
- Current unrestricted licensure as a physician, registered nurse, advanced practice nurse, or physician assistant
- At least 60 relevant education/training hours completed within the preceding 5 years
- At least 2 years of clinical cancer-genetics/risk-assessment experience
NCBC also allows for individual board review for other qualified professionals who don't fit neatly into the licensure categories above, and importantly, no single training course is mandated to meet the education-hours requirement - candidates can assemble qualifying hours from multiple sources. For a full walk-through of how to document and verify eligibility before you register, see CGRA Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Registration, Fees, and Testing Logistics
Registration must be submitted at least 2 weeks before your intended testing date, and once your registration is approved, NCBC emails the candidate handbook within 7 days. Plan your timeline backward from your target test date accordingly - waiting until the last minute compresses both your prep window and your ability to resolve any eligibility questions.
For remote testing specifically, candidates need a clear single-monitor workspace, a functioning webcam, microphone, and speakers, and valid photo ID. You must test alone, with no phones or headphones present, and unauthorized aids of any kind are prohibited. These aren't suggestions - they're conditions for a valid exam attempt, so confirm your setup well before exam day rather than troubleshooting in the final hour.
On cost specifically: the initial exam fee is $495. If a retake is needed, NCBC requires at least 6 months between attempts. The first retake within 12 months carries no additional exam fee, but an attempt after a second failure costs $495 again. A full cost breakdown, including renewal fees, is available in CGRA Certification Cost 2026: Complete Pricing Breakdown, and testing windows are detailed in CGRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Maintaining the Credential
CGRA certification isn't a one-time achievement. Annual renewal requires 8 cancer-genetics/risk-assessment education credits plus a $150 fee with 3.1% processing added on top. Miss the deadline and the credential doesn't disappear immediately - it enters inactive status 60 days past expiration, with full decertification occurring 1 year past expiration. That grace period exists, but it's not something to plan around; treat renewal deadlines as fixed.
Mapping Study Time to Domain Weight
Generic study techniques - spaced repetition, timed practice blocks, active recall - all work, but only if they're pointed at the right material. For CGRA specifically, that means weighting your study calendar toward Domain 3 (Genetic Test Interpretation, 32%) and Domain 5 (Patient Communication/Counseling, 25%) rather than splitting your time evenly across all five domains.
Domain 3 Foundation
- Variant classification systems and how pathogenic vs. VUS findings are reported
- Test-type scope: single-gene panels vs. multi-gene panels vs. broader sequencing
Domain 5 and Domain 2 Together
- Pre- and post-test counseling frameworks and informed consent structure
- Risk model selection and interpreting quantitative outputs (ties directly into how you'll counsel on results)
Domains 1 and 4, Then Full Review
- Pedigree conventions and red-flag family history patterns
- Management guideline mapping by mutation and risk category, followed by full-length timed practice
Notice the sequencing: interpretation and counseling come first because they carry the most exam weight and because Domain 5 questions frequently build on Domain 2 and Domain 3 knowledge - you can't counsel a patient on a result you haven't correctly interpreted. For a complete study framework including question-style breakdowns and pacing strategy for the 3-hour limit, see CGRA Study Guide 2026: How to Pass on Your First Attempt, and for a candid assessment of where candidates typically struggle, How Hard Is the CGRA Exam? Complete Difficulty Guide 2026 is worth reading before you finalize your timeline.
Once you've built domain knowledge, timed practice questions modeled on the actual 120-question, 3-hour format at our CGRA practice test platform help you find pacing problems before exam day - a common issue given how dense Domain 3 interpretation questions can be under time pressure.
Putting the Definition in Practice
Knowing that CGRA stands for Cancer Genetic Risk Assessment is the starting point, not the finish line. What actually matters for your career or exam prep is understanding NCBC's specific format: 120 questions, a 71% criterion-referenced pass mark, five weighted domains dominated by test interpretation and patient counseling, and a renewal cycle that keeps the credential active only through ongoing education. If you're just beginning to map out your path toward certification, our related explainers - What Is A CGRA?, What Is CGRA Certification?, and CGRA Training - fill in adjacent context, and reviewing pass-rate data at CGRA Pass Rate 2026: What the Data Shows can help calibrate how much preparation time to budget. When you're ready to test your recall against realistic questions, our practice exams are built around this exact five-domain structure.
Frequently Asked Questions
CGRA stands for Cancer Genetic Risk Assessment, a clinical certification administered by the National Consortium of Breast Centers (NCBC) for clinicians who assess hereditary cancer risk and interpret genetic test results.
The National Consortium of Breast Centers, Inc. (NCBC) administers the CGRA exam, sets eligibility requirements, and manages renewal policy.
The exam has 120 multiple-choice questions - 100 scored and 20 unscored - with a 3-hour time limit and a required score of 71% or higher to pass.
Domain 3, Interpret Relevant Genetic Test Results, is the largest at 32% of the exam. Domain 5, Patient Communication/Counseling, is second-largest at 25%.
No. NCBC requires 60 relevant education/training hours within the preceding 5 years and 2 years of clinical experience, but no single mandatory training course is required to meet those hours.