What Should I Know?

What do I need to know for the examination?

All candidates, regardless of professional licensure or certification, are required to pass the examination to be awarded the NCBC CGRA certification. The exam is conducted in a secure, proctored environment and consists of 120 items, (100 scored, 20 unscored) with 3 hours allowed for the examination. The items are multiple choice with one best answer covering the following 5 domains:

Domain 1: Collect and document pertinent patient and family history (15%)

Domain 2: Perform personalized cancer risk assessment (18%)

Domain 3: Interpret relevant genetic test results (32%)

Domain 4: Determine medical management options based on genetic test results and risk factors (10%)

Domain 5: Effectively communicate with and counsel patients (25%)

Successful completion of the assessment exam is required to receive the certification.
Expected candidate knowledge, skills and competencies assessed within the 5 domains include:

  1. Understand basic principles of cancer genetics – including but not limited to inheritance patterns, genetic terminology and the genetic nature of common hereditary cancer predisposition syndromes
  2. Understand basic principles of tumor genomics
    1. Recognize common genomic tumor drivers: i.e. HER-2, ER, PR, DNA Mismatch Repair Deficiency, and MSI
    2. Recognize when tumor genomic testing results may be indicative of an underlying germline cancer predisposition syndrome
  3. Document pertinent patient and family history information
    1. Obtain and document a 3-4 generation family pedigree focused on cancer diagnoses and including family ancestry when known
    2. Document personal history information that may be associated with cancer risk in general including smoking history, alcohol use, physical inactivity, prior radiation therapy
    3. Document personal history information that may be associated with breast cancer risk including breast density, parity, age at menarche, age at first live birth, age at menopause, hormone use, DES exposure, history of proliferative breast biopsy (ADH, AHL, LCIS), previous thoracic radiation
  4. Identify individuals eligible for genetic counseling and testing based on personal history, family history, tumor genomic testing results
  5. If providing genetic testing within scope of practice (licensure, scope of knowledge)
    1. Understand the principles of informed consent.
    2. Discuss the risks, benefits and limitations of genetic testing
    3. Explain the possible outcomes of genetic testing to individuals who elect to proceed with testing
  6. Accurately interpret genetic test results and make or explain the proper medical management recommendations to the patient and their at-risk family members. This includes positive results, negative results (true negative and uninformative negative), as well as variants of uncertain significance and other inconclusive results
  7. Utilize relevant breast cancer risk assessment models to guide personalized screening and risk management strategies, accounting for the benefits and limitation of the various models. (i.e. Tyrer-Cuzick/IBIS, Claus, Gail, BOIDAICEA)
  8. Understand one’s limitations based on scope of practice and or complexity of findings and refer/recommend referral to other professionals with expertise in the field
  9. Access the most current sites for interpretation of genetic variants and cancer risk such as ClinVar

What does certification mean?

For the Candidate:

The intended use of the NCBC CGRA examination and certification is to verify that candidates have met the NCBC criteria for competent, specialized level healthcare professional providing Cancer Genetics Risk Assessment clinical practice before awarding certification.

The CGRA certification exam meets the definition of a voluntary certification examination, as opposed to a required licensure examination.  While state licensure provides the legal credentials for health care professionals such as advanced practice nurses, physicians, physician assistants, voluntary certification in the NCBC Cancer Genetics Risk Assessment program indicates compliance with the professional standards for practices in this clinical subspecialty. While the CGRA exam can be considered a high stakes certification examination, it is not a mandatory licensure examination or the only option for recognizing healthcare professionals providing cancer genetics risk assessment specialty practice.

Appropriate Use of CGRA Examination Scores and Subsequent Certification:

Passing candidates who are award the certification in CGRA should be able to present themselves to employers and the public as having demonstrated the competence and experience necessary for specialized level practice. Candidates who fail the examination should be able to gain enough information from their score reports to help guide study efforts for remediation and future retakes. Healthcare professionals providing Cancer Genetics Risk Assessment education programs may use the content of the published CGRA exam blueprint to ensure their curriculum encompasses the full domain of the certification exam. Members of the public should have the right to verify certification if warranted.

Plans for Additional Recognition:

Additionally, NCBC will be working with stakeholder organizations such as the Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC) to have professionals with the NCBC certification in CGRA recognized as meeting the standards outlined for Genetic Evaluation and Management once the test validation process has been completed with the first group of test takers.

Similarly, NCBC will be working with insurance companies for recognition of this professional certification in CGRA as demonstrating the competence and experience necessary to: obtain informed consent for genetic testing, order genetic testing if indicated within scope of practice and licensure and adequately interpret and act upon results.


Please note that the NCBC CGRA certification does not qualify individuals to practice broad-spectrum genetic counseling outside the realm of cancer genetics, risk assessment. CGRA certification is not a path to and does not indicate eligibility for certification or licensure as a genetic counselor. Genetic counselors and geneticists are required to attain a masters or doctoral degree in genetics and specialty certification that encompasses the full spectrum of human genetics. Therefore, no holder of the NCBC certification in Cancer Genetics Risk Assessment should represent themselves as equivalent with a genetic counselor. NCBC would consider such misrepresentation as grounds for revocation of the certification and the possibility of disciplinary action.