- What Is CGRA Certification?
- Who Governs the CGRA Credential?
- Eligibility and Prerequisites
- Exam Format and Scoring
- The Five CGRA Exam Domains
- Registration, Fees, and Testing Logistics
- Who Hires CGRA-Certified Professionals?
- Renewal and Maintaining Certification
- How to Approach CGRA Preparation
- Frequently Asked Questions
- CGRA stands for Cancer Genetic Risk Assessment, governed 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 an unrestricted clinical license, 60 relevant education hours, and 2 years of clinical experience.
What Is CGRA Certification?
CGRA certification stands for Cancer Genetic Risk Assessment, a credential designed for licensed clinicians who evaluate patients' hereditary cancer risk, interpret genetic test results, and guide medical management decisions. It is not a general genetics credential and it is not affiliated with any other program that happens to share the same three-letter acronym. If you're just getting oriented, our companion piece on What Is CGRA? covers the basics, while CGRA Meaning and What Does CGRA Stand For? dig into terminology if you've seen the acronym used elsewhere.
This article focuses specifically on the certification process itself: who administers it, what the exam covers, what it costs, and what happens after you pass. For a broader overview of the credential as a professional designation, see CGRA Certification.
Who Governs the CGRA Credential?
The CGRA credential is administered by the National Consortium of Breast Centers, Inc. (NCBC). NCBC controls the exam content outline, eligibility requirements, testing policy, and renewal process. The current exam is based on the CGRA Exam Description v2, which was uploaded in July 2023 and remains the version linked from NCBC's certification page as of this writing. Because the credential is periodically revised, candidates should always confirm they're studying against the currently published exam description rather than an outdated summary.
NCBC also publishes annual results. In the most recently completed reporting period, 20 of 23 candidates passed - a rounded rate of 87.0% calculated directly from NCBC's published counts. A separate, more recent posting shows 5 candidates and 5 passes, but NCBC notes this reflects an in-progress period rather than a completed annual cycle. For a deeper breakdown of what these numbers mean for your own preparation strategy, see CGRA Pass Rate 2026: What the Data Shows.
Eligibility and Prerequisites
CGRA certification is not open to just anyone with an interest in genetics. Candidates must meet all of the following before they can sit for the exam:
- Current, unrestricted licensure as a physician, registered nurse, advanced-practice nurse, or physician assistant
- At least 60 hours of relevant cancer-genetics education or training completed within the preceding 5 years
- At least 2 years of clinical experience specifically in cancer-genetics risk assessment
NCBC does not mandate any single training course to satisfy the education-hours requirement, which gives candidates flexibility in how they accumulate the necessary background - through conferences, formal coursework, employer-sponsored training, or a mix of sources. Professionals who don't fit neatly into the four licensed categories above may request an individual board review of their qualifications.
Our detailed breakdown at CGRA Requirements 2026: Eligibility, Prerequisites & How to Qualify walks through documentation tips for each prerequisite category.
Key Takeaway
If you're an RN or APN considering CGRA, start logging your clinical cancer-genetics hours now - NCBC looks back 5 years, and gaps in documentation can delay your application.
Exam Format and Scoring
The CGRA exam consists of 120 multiple-choice questions: 100 scored items and 20 unscored (pretest) items that are indistinguishable from scored questions during the test. Candidates have a 3-hour time limit to complete the exam. Because scored and unscored items are mixed together, there's no way to identify which questions "count" - every question deserves full attention.
Passing requires a score of 71% or higher. This is a criterion-referenced cutoff, meaning it's set based on a defined standard of minimum competency rather than adjusted relative to how other candidates perform on a given administration. In practice, that means your score is not curved against other test-takers - you either demonstrate the required competency level or you don't. Our full explainer at CGRA Passing Score 2026: Exactly What You Need to Pass covers how this scoring model affects preparation decisions.
The Five CGRA Exam Domains
Understanding how content is weighted across the exam is one of the most important steps in building an efficient study plan. NCBC's exam description breaks the CGRA exam into five domains:
Domain 1: Collect and Document Pertinent Patient and Family History (15%)
Covers the intake process - pedigree construction, identifying red-flag family history patterns, and documenting information accurately enough to support downstream risk calculations.
- Three-generation pedigree conventions and symbols
- Recognizing hereditary cancer syndrome red flags in family history
Domain 2: Perform Personalized Cancer Risk Assessment (18%)
Focuses on applying risk-assessment models and clinical judgment to translate collected history into an individualized risk profile.
- Quantitative and qualitative risk models
- Determining who meets criteria for genetic testing referral
Domain 3: Interpret Relevant Genetic Test Results (32%)
The single largest domain on the exam, requiring fluency in variant classification, gene-specific cancer risk associations, and result interpretation nuance.
- Pathogenic, likely pathogenic, benign, and variant-of-uncertain-significance classifications
- Gene-specific penetrance and associated cancer risks across major hereditary syndromes
Domain 4: Determine Medical Management Options (10%)
Tests knowledge of how risk assessment and genetic results translate into actionable clinical recommendations.
- Surveillance protocols based on risk tier
- Risk-reducing surgical and chemopreventive options
Domain 5: Effectively Communicate With and Counsel Patients (25%)
The second-largest domain, emphasizing the interpersonal and ethical dimensions of delivering genetic information.
- Pre- and post-test counseling frameworks
- Communicating uncertainty (e.g., variants of uncertain significance) without causing undue alarm
Notice that Domains 3 and 5 together account for 57% of the entire exam. That single fact should drive most of your study-time allocation. For a domain-by-domain study strategy, see CGRA Exam Domains 2026: Complete Guide to All 5 Content Areas.
| Domain | Weight | Relative Priority |
|---|---|---|
| Genetic Test Interpretation | 32% | Highest |
| Patient Communication/Counseling | 25% | High |
| Personalized Risk Assessment | 18% | Moderate |
| Patient/Family History Collection | 15% | Moderate |
| Medical Management Options | 10% | Lower |
Registration, Fees, and Testing Logistics
The initial CGRA examination fee is $495. Candidates must apply at least 2 weeks before their intended testing date, and once an application is approved, NCBC emails the candidate handbook within 7 days. Because of this lead time, it's worth planning backward from your target testing window rather than assuming you can register at the last minute - our CGRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling guide walks through the practical timeline.
Candidates who fail have a defined retake path: at least 6 months must pass between attempts. The first retake within 12 months carries no additional exam fee, but if a candidate fails a second time, the next attempt costs the full $495 again. This structure rewards prompt, focused retesting over repeated delayed attempts.
If you're testing remotely, logistics matter as much as content knowledge. Remote testing requires a valid photo ID, a clear workspace with a single monitor, a functioning webcam, microphone, and speakers, and the candidate must be alone in the room - no phones, no headphones, and no unauthorized aids of any kind. Violating these conditions can jeopardize your results regardless of how well you know the material.
For a complete cost picture including renewal fees, see CGRA Certification Cost 2026: Complete Pricing Breakdown.
Who Hires CGRA-Certified Professionals?
CGRA-certified clinicians typically work in settings where cancer risk assessment and genetic counseling intersect with direct patient care: breast centers, high-risk cancer clinics, oncology practices, and hospital genetics programs. Because the credential is open to physicians, RNs, APNs, and PAs, it's frequently pursued by clinicians who already work adjacent to genetic counselors but want a credential that formally validates their competency in risk assessment and result interpretation - not genetic counseling licensure itself.
If you're weighing whether pursuing this credential makes sense for your career trajectory, our analyses at CGRA Salary Guide 2026: Complete Earnings Analysis and Is the CGRA Certification Worth It? Complete ROI Analysis 2026 break down the practical considerations. For those exploring the job market itself, see CGRA Jobs.
Renewal and Maintaining Certification
CGRA certification is not permanent - it requires annual maintenance. Renewal requires 8 continuing education credits in cancer-genetics/risk-assessment topics each year, along with a $150 renewal fee plus 3.1% processing. Missing the deadline doesn't result in immediate loss of certification: NCBC places lapsed certificants into inactive status starting 60 days past expiration, and full decertification occurs at 1 year past expiration. That window gives certificants a reasonable grace period to catch up on missed credits, but it shouldn't be relied on as a routine buffer.
How to Approach CGRA Preparation
Because Domain 3 (genetic test interpretation) and Domain 5 (patient communication/counseling) together make up more than half the exam, an efficient study plan front-loads time on those two areas rather than spreading effort evenly across all five domains. A simple weekly structure might look like this:
Domain 3 Foundations
- Review variant classification categories and gene-specific penetrance data
- Work through practice items focused on interpreting ambiguous or borderline results
Domain 5 and Domain 2
- Practice counseling scenarios, especially communicating uncertain results
- Review quantitative risk models and referral criteria
Domains 1 and 4, Then Full Review
- Cover pedigree conventions and medical management protocols
- Take timed practice exams under 3-hour conditions to build pacing
This structure isn't a rigid formula - it's a starting point that reflects the exam's actual weighting. For a fuller walkthrough of preparation strategy, including how to handle the unscored/scored question mix on test day, see CGRA Study Guide 2026: How to Pass on Your First Attempt. And if you're still trying to gauge how demanding the exam really is relative to your current clinical background, How Hard Is the CGRA Exam? Complete Difficulty Guide 2026 offers an honest assessment.
Practicing under realistic, timed conditions matters more for CGRA than for many other credentials, given the 3-hour limit across 120 questions. Running full-length timed practice sets on our practice test platform before exam day helps surface pacing issues while there's still time to adjust your approach. A short daily review paired with periodic full-length runs on CGRA Exam Prep's practice tests tends to work better than long, infrequent cram sessions. Keeping a condensed reference nearby, like our CGRA Cheat Sheet 2026: One-Page Review of Must-Know Facts, can also help during final review.
Frequently Asked Questions
CGRA stands for Cancer Genetic Risk Assessment, a certification administered by the National Consortium of Breast Centers (NCBC) for licensed clinicians. See What Does CGRA Mean? for more on the terminology.
The exam has 120 multiple-choice questions total: 100 scored and 20 unscored items, all within a 3-hour time limit.
Candidates must score 71% or higher. The score is criterion-referenced, meaning it's based on a fixed competency standard rather than curved against other test-takers.
The initial exam fee is $495. Retakes within 12 months of a first failure carry no additional fee, but a second failure requires paying the full $495 again for the next attempt.
No single training course is mandatory. Candidates need at least 60 relevant education/training hours within the preceding 5 years, which can come from a variety of sources, plus 2 years of clinical cancer-genetics experience.