- CGRA stands for Cancer Genetic Risk Assessment, governed 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 communication (25%) make up 57% of the exam content.
- Eligibility requires an active clinical license, 60 education hours in 5 years, and 2 years of relevant experience.
What CGRA Actually Stands For
CGRA stands for Cancer Genetic Risk Assessment. It is a specialty credential recognizing clinicians who identify, evaluate, and counsel patients at increased hereditary risk for cancer. This is not a generic genetics credential - it is built specifically around the clinical workflow of collecting family history, ordering and interpreting genetic tests, and translating results into medical management and patient counseling.
If you landed here after searching other pages about the acronym, note that this site covers only the Cancer Genetic Risk Assessment credential. For deeper dives into the terminology itself, see our companion posts on CGRA Meaning, What Does CGRA Stand For?, and What Does CGRA Mean?.
Who Runs the CGRA Credential
The CGRA credential is administered by the National Consortium of Breast Centers, Inc. (NCBC). NCBC oversees the exam content, registration process, scoring, and renewal requirements. The examination itself is delivered either as a paper/pencil test at designated sites or via live-remote proctoring, with the most recently published administration policy naming Examity as the remote-proctoring vendor.
Because NCBC is a specific governing body with specific published policies, candidates should always work from NCBC's current materials rather than assuming details from other certifications that happen to share the same three-letter acronym. For a full walkthrough of what earning this credential involves, see CGRA Certification and What Is CGRA Certification?.
Who Can Sit for the Exam
NCBC restricts eligibility to clinicians who are already working in patient care, not entry-level candidates. To register, you generally need:
- Current, unrestricted licensure as a physician, registered nurse, advanced-practice nurse, or physician assistant
- At least 60 hours of relevant education or training completed within the preceding 5 years
- At least 2 years of clinical experience specifically in cancer genetics or risk assessment
Professionals who don't fit neatly into those license categories can request an individual board review from NCBC. There is no single mandatory training course you must complete first - candidates typically arrive via a mix of CME, professional conferences, on-the-job mentorship, and self-directed study. A full breakdown of these criteria, including how the individual review process works, is covered in CGRA Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Key Takeaway
You cannot "cram" your way into eligibility - the license, hours, and clinical-experience requirements exist before you can even register, so plan your career path toward CGRA well before exam week.
Exam Format and Question Style
The current exam blueprint is documented in NCBC's CGRA Exam Description (version 2, uploaded July 2023), which candidates should review directly before registering. Structurally, the exam consists of:
- 120 multiple-choice questions - 100 scored and 20 unscored (unscored items are used for future exam development but are indistinguishable to the test-taker)
- 3-hour time limit for the full exam
- 71% passing score, which is criterion-referenced rather than curved against other candidates' performance
Because the passing standard is criterion-referenced, your score is compared to a fixed competency threshold, not to how everyone else in your testing window performed. For a detailed explanation of what that 71% actually requires in terms of correct answers and preparation margin, read CGRA Passing Score 2026: Exactly What You Need to Pass.
Question style leans heavily on applied clinical scenarios rather than pure recall - expect pedigree interpretation, variant classification reasoning, and counseling-response questions framed around realistic patient cases. If you want a broader sense of how tough this makes the exam relative to other clinical certifications, see How Hard Is the CGRA Exam? Complete Difficulty Guide 2026.
The Five Content Domains
The exam blueprint is organized into five domains, and two of them dominate the test. Understanding this weighting is the single most important strategic decision you'll make in prep - it should shape how many hours you allocate to each topic.
Domain 1: Collect and Document Pertinent Patient and Family History (15%)
Covers structured intake of three-generation pedigrees, red-flag identification, and documentation standards.
- Recognizing hereditary cancer syndrome patterns in family trees
- Standard pedigree symbols and nomenclature
Domain 2: Perform Personalized Cancer Risk Assessment (18%)
Applies quantitative and qualitative risk models to an individual patient's history.
- Using established risk-assessment models appropriately
- Differentiating average, moderate, and high-risk categorization
Domain 3: Interpret Relevant Genetic Test Results (32%)
The largest domain by far - nearly a third of the scored exam. Focuses on translating lab reports into clinical meaning.
- Distinguishing pathogenic, benign, and variant-of-uncertain-significance results
- Understanding test methodology limitations and result nuance
Domain 4: Determine Medical Management Options (10%)
Smallest domain, but tests your ability to connect a genetic finding to concrete next steps.
- Surveillance intervals and risk-reducing interventions
- Matching management guidelines to specific mutation findings
Domain 5: Effectively Communicate With and Counsel Patients (25%)
Second-largest domain, testing communication competency in emotionally complex scenarios.
- Delivering results with appropriate psychosocial sensitivity
- Informed consent and shared decision-making language
Domains 3 and 5 together account for 57% of the scored content - more than half the exam. Any study plan that treats all five domains equally is misallocating your limited prep time. For a domain-by-domain study breakdown with example question types, see CGRA Exam Domains 2026: Complete Guide to All 5 Content Areas.
Registration, Fees, and Testing Day
The initial examination fee is $495. Registration must be completed at least 2 weeks before your intended testing date, and once NCBC approves your application, the candidate handbook is emailed within 7 days.
If you're testing remotely rather than at a physical site, be prepared for strict environment requirements:
- Valid photo ID for identity verification
- A clear, single-monitor workspace with no extra materials visible
- Working webcam, microphone, and speakers
- You must be alone in the room - no phones, headphones, or unauthorized aids permitted
If you fail, retakes require waiting at least 6 months between attempts. Your first retake within 12 months carries no additional exam fee, but if you fail a second time, the next attempt costs the full $495 again. For the complete fee schedule including renewal costs, see CGRA Certification Cost 2026: Complete Pricing Breakdown, and for scheduling logistics and administration windows, check CGRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
| Item | Detail |
|---|---|
| Initial exam fee | $495 |
| Question count | 120 total (100 scored, 20 unscored) |
| Time limit | 3 hours |
| Passing score | 71% or higher |
| First retake (within 12 months) | No additional fee |
| Retake after second failure | $495 |
| Minimum gap between attempts | 6 months |
Maintaining the Credential
CGRA certification isn't a one-time achievement - it requires ongoing renewal. Each year, certified professionals must complete 8 cancer-genetics/risk-assessment education credits and pay a $150 renewal fee plus 3.1% processing. Missing the deadline doesn't result in immediate loss of the credential, but the timeline is unforgiving: your status moves to inactive 60 days past expiration, and full decertification follows 1 year past expiration if renewal isn't completed.
Key Takeaway
Set a renewal reminder well before your expiration date - the 60-day inactive window and 1-year decertification deadline leave little room for procrastination once you're past due.
Who Hires CGRA-Certified Professionals
CGRA-credentialed clinicians typically work in roles centered on hereditary cancer risk, including genetic counseling-adjacent nursing positions, breast center risk-assessment clinics, oncology navigation programs, and multidisciplinary cancer risk clinics. Because the credential requires an existing clinical license (physician, RN, APN, or PA), it functions as an added specialty layer on top of an existing scope of practice rather than a standalone entry-level job qualification.
If you're evaluating whether pursuing this credential fits your career plans, our guides on CGRA Jobs and Is the CGRA Certification Worth It? Complete ROI Analysis 2026 walk through job settings, and CGRA Salary Guide 2026: Complete Earnings Analysis covers compensation considerations. For clinicians weighing formal coursework options before applying, CGRA Training outlines common preparation pathways.
Mapping a Study Timeline to the Domains
Generic study techniques - spaced repetition, timed practice blocks, active recall - only matter if they're pointed at the right material. Given that Domains 3 and 5 make up 57% of the exam, your weekly schedule should reflect that weighting rather than splitting time evenly across all five domains.
Foundations: Domains 1 & 2
- Review pedigree construction and family-history red flags
- Practice applying risk-assessment categorization to sample cases
Deep Focus: Domain 3
- Drill variant classification (pathogenic vs. VUS vs. benign) scenarios
- Study lab report interpretation and methodology limitations
Domain 4
- Match specific findings to surveillance and management guidelines
Domain 5 & Full Review
- Practice counseling-scenario question types
- Take full-length timed practice sessions under 3-hour conditions
For a more detailed week-by-week plan with specific resource recommendations, see CGRA Study Guide 2026: How to Pass on Your First Attempt, and for a condensed reference you can review the week before your test, check the CGRA Cheat Sheet 2026: One-Page Review of Must-Know Facts. You can also reinforce your readiness with timed practice exams on our practice test platform, which mirrors the 120-question, 3-hour format so you build endurance before test day.
Frequently Asked Questions
CGRA stands for Cancer Genetic Risk Assessment, a credential administered by the National Consortium of Breast Centers (NCBC) for clinicians who assess hereditary cancer risk. See also What Is A CGRA? for more on the term itself.
The exam has 120 multiple-choice questions - 100 scored and 20 unscored - with a 3-hour time limit.
You need 71% or higher. The standard is criterion-referenced, meaning it's a fixed competency bar rather than a curve based on other candidates.
You must wait at least 6 months before retesting. Your first retake within 12 months has no additional fee, but a retake after a second failure costs $495.
No. NCBC does not mandate a single training course. You do need 60 relevant education/training hours within the preceding 5 years and 2 years of clinical cancer-genetics/risk-assessment experience, alongside an active qualifying license.