- A CGRA is a Cancer Genetic Risk Assessment credential issued by the National Consortium of Breast Centers (NCBC).
- 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 counseling (25%) together make up 57% of the exam.
- Eligibility requires an active clinical license, 60 relevant education hours in 5 years, and 2 years of hands-on experience.
What Is A CGRA, Exactly?
A CGRA (Cancer Genetic Risk Assessment) credential identifies a clinician who has demonstrated competency in evaluating a patient's personal and family cancer history, interpreting genetic test results, and translating that information into medical management decisions and patient counseling. It is not a general "genetics" certificate - it is specifically built around the workflow of cancer risk clinics: intake, pedigree analysis, risk modeling, test interpretation, and communication.
If you've landed here searching "what is a CGRA," you're likely a nurse, advanced-practice nurse, physician assistant, or physician working in or moving toward a cancer risk clinic, breast center, or genetics counseling setting. This article breaks down exactly what the designation covers, who administers it, and what the exam actually tests - with none of the guesswork.
Who Administers the CGRA Credential
The CGRA is issued by the National Consortium of Breast Centers, Inc. (NCBC). NCBC administers the examination itself - candidates sit either a paper/pencil exam or a live-remote-proctored version. The currently linked administration policy (dated March 2023) names Examity as the remote-proctoring vendor, so if you register for a remote sitting, expect ID verification, webcam and microphone checks, and a locked-down single-monitor workspace with no phones or headphones nearby.
Because NCBC controls the content, scoring, and administration end to end, the exam description document is the authoritative source for what's tested. The version currently linked on NCBC's site is CGRA Exam Description v2, uploaded July 2023 - worth reviewing directly before you finalize a study plan.
Key Takeaway
Always confirm you're studying against the NCBC Cancer Genetic Risk Assessment materials - not a similarly-named credential from a different governing body. The acronym overlaps elsewhere, but the content, fees, and prerequisites here are specific to NCBC's CGRA.
Who Earns A CGRA and Why
CGRA holders typically work in settings where cancer risk is assessed as a distinct clinical service: breast centers, hereditary cancer clinics, oncology practices, and genetics-focused nursing roles. The credential signals to employers and referring physicians that the clinician can independently manage the risk-assessment pathway - not just order a test, but interpret it and counsel the patient on next steps.
If you're weighing whether this is the right investment for your career stage, our breakdown on whether the CGRA certification is worth it walks through the ROI question in more depth, and the CGRA jobs overview covers where this credential tends to open doors.
Eligibility: Who Can Sit for the Exam
NCBC does not open the CGRA exam to anyone off the street. To qualify, a candidate generally needs:
- Current, unrestricted licensure as a physician, registered nurse, advanced-practice nurse, or physician assistant
- At least 60 relevant education/training hours in cancer genetics or risk assessment within the preceding 5 years
- At least 2 years of clinical experience in cancer-genetics/risk-assessment work
Notably, there is no single mandatory training course - candidates can accumulate their 60 hours through a mix of conferences, coursework, and clinical education. Other qualified professionals who don't fit the standard licensure categories may request an individual board review. For the full breakdown of documentation and edge cases, see our dedicated CGRA requirements guide.
Exam Format and Question Style
The CGRA exam is 120 multiple-choice questions: 100 are scored and 20 are unscored (used for item development), though candidates don't know which is which during the test. You get a 3-hour time limit, and the passing score is 71%. This is a criterion-referenced cut score - it isn't curved against how other candidates performed, so your job is to hit the fixed bar, not to outscore a cohort.
Questions are scenario-driven rather than pure recall. Expect vignettes describing a patient's pedigree, a lab report excerpt, or a counseling interaction, followed by a question asking you to apply risk-assessment logic or interpret a result. If you want a sense of how tough this actually feels in practice, our difficulty guide unpacks the exam's demands question type by question type.
| Exam Detail | Specification |
|---|---|
| Total questions | 120 (100 scored, 20 unscored) |
| Time limit | 3 hours |
| Passing score | 71% or higher |
| Scoring method | Criterion-referenced, not curved |
| Testing modes | Paper/pencil or live remote-proctored |
The Five CGRA Exam Domains
The exam content is organized into five domains, and the weighting tells you exactly where to focus your energy. Two domains - genetic test interpretation and patient communication/counseling - make up 57% of the entire exam combined.
Domain 1: Collect and Document Pertinent Patient and Family History (15%)
Covers building an accurate three-generation pedigree, recognizing red-flag family history patterns, and documenting findings in a way that supports downstream risk modeling.
- Pattern recognition across multiple cancer types in one family
- Accurate pedigree notation and documentation standards
Domain 2: Perform Personalized Cancer Risk Assessment (18%)
Tests application of risk-assessment models and clinical judgment to translate collected history into a quantified or qualitative risk estimate.
- Selecting the right risk model for the clinical scenario
- Integrating personal risk factors with family history data
Domain 3: Interpret Relevant Genetic Test Results (32%)
The single largest domain. Candidates must accurately read variant classifications, understand testing panel scope and limitations, and know how ambiguous or variant-of-uncertain-significance results should be handled.
- Distinguishing pathogenic, benign, and uncertain variant classifications
- Understanding panel limitations and when additional testing is warranted
Domain 4: Determine Medical Management Options (10%)
Focuses on connecting a risk assessment or test result to appropriate surveillance, chemoprevention, or surgical management pathways.
- Matching risk level to screening intensity and timing
- Knowing when a management recommendation requires specialist referral
Domain 5: Effectively Communicate With and Counsel Patients (25%)
The second-largest domain. Tests the ability to explain complex genetic concepts, deliver results (including uncertain ones), and support patient decision-making without overstepping scope.
- Explaining variant-of-uncertain-significance results in plain language
- Counseling around psychosocial impact and informed consent
For a deeper, section-by-section breakdown of what to actually study within each domain, see the complete CGRA exam domains guide.
Registration, Fees, and Retakes
The initial examination fee is $495. Registration must be submitted at least two weeks before your intended testing date, and once your registration is approved, NCBC emails the exam handbook within 7 days.
If you're testing remotely, plan your environment in advance: a clear single-monitor workspace, a valid photo ID, a functioning webcam, microphone, and speakers, and you must be completely alone in the room - no phones, no headphones, no unauthorized materials nearby.
If you don't pass on your first attempt, you must wait at least 6 months before retesting. The first retake within 12 months of the original attempt comes with no additional exam fee. If you fail a second time, any subsequent attempt costs the full $495 again. For the complete cost picture including renewal fees, see our CGRA certification cost breakdown, and for exact registration windows, check CGRA exam dates and testing windows.
Key Takeaway
Budget your prep timeline around the two-week registration deadline and the 7-day handbook turnaround - waiting until the last minute compresses your study window unnecessarily.
Maintaining the Credential
The CGRA isn't a one-time achievement - it requires annual renewal. Each year, certified professionals must complete 8 cancer-genetics/risk-assessment education credits and pay $150 plus 3.1% processing. Miss the deadline and your status becomes inactive 60 days past expiration; go a full year past expiration without renewing and you'll be decertified entirely.
This renewal structure rewards staying current in the field rather than treating certification as a static credential - which makes sense given how quickly variant classification guidance and panel technology evolve in cancer genetics.
A Domain-Weighted Prep Approach
Because Domain 3 (32%) and Domain 5 (25%) together account for more than half the exam, your study time should not be split evenly across all five domains. A reasonable allocation weights time roughly proportional to domain percentage, with extra review time reserved for genetic test interpretation since it's the densest, most technical content area.
Foundational Domains
- Domain 1: pedigree collection and documentation standards
- Domain 2: risk-assessment model selection and application
Heaviest-Weighted Domain
- Domain 3: variant classification, panel scope, uncertain results
- Practice interpreting sample lab reports under timed conditions
Management and Counseling
- Domain 4: matching risk tier to management pathway
- Domain 5: communication scenarios and informed-consent language
Full Review and Timed Practice
- Full-length practice runs against the 3-hour limit
- Targeted review of weakest domain based on practice results
Spaced review works especially well for Domain 3 content specifically, since variant classification terminology tends to fade quickly without repetition. For a more detailed week-by-week plan and resource list, see our full CGRA study guide for 2026, and if you want the passing-score math spelled out clearly, read exactly what score you need to pass. Once you're ready to test your recall quickly, a condensed CGRA cheat sheet can help with final review.
Putting It All Together
A CGRA is a specific, NCBC-administered credential confirming that a licensed clinician can competently collect family history, assess personalized cancer risk, interpret genetic test results, guide management decisions, and counsel patients through all of it. The exam's weighting toward test interpretation and communication tells you where to invest your prep hours, and the prerequisites ensure candidates arrive with real clinical grounding rather than classroom knowledge alone.
Whether you're just discovering the acronym or actively registering for a testing window, understanding the mechanics - fees, retake rules, domain weights, renewal cycle - puts you in a far stronger position than guessing at generic exam advice. Start with the domains, build outward from there, and use realistic practice questions to confirm your readiness before test day.
Frequently Asked Questions
CGRA stands for Cancer Genetic Risk Assessment, a certification administered by the National Consortium of Breast Centers (NCBC) for clinicians working in cancer risk evaluation. See our dedicated CGRA meaning page for more context.
Licensed physicians, registered nurses, advanced-practice nurses, and physician assistants with at least 60 relevant education hours in the prior 5 years and 2 years of clinical cancer-genetics experience. Other professionals may request individual board review.
The exam has 120 multiple-choice questions - 100 scored and 20 unscored - with a 3-hour time limit and a passing score of 71%.
You must wait at least 6 months before retaking. The first retake within 12 months has no additional fee; a further attempt after a second failure costs the full $495 exam fee again.
Renew annually with 8 cancer-genetics/risk-assessment education credits and a fee of $150 plus 3.1% processing. Status goes inactive 60 days past expiration and is decertified 1 year past expiration.