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Purpose: To determine if breast cancer stage exhibits any significant variation between African Americans and white Americans., Methods: We conducted a retrospective cohort study. Inclusion criteria required a diagnosis of breast cancer that was reported to the TriHealth tumor registry from 1991-2003. For each patient, we collected data on race; American Joint Committee on Cancer stage at diagnosis; and 12 potential confounding variables, including topography, morphology, laterality, age, menopausal age, smoking status, estrogen and progesterone receptor status, marital status, menopausal status, family history of breast cancer in a first-degree relative and insurance status., Results: 5,751 patients (5,119 Caucasians, 632 African Americans) were eligible to be included in the study. African Americans were significantly younger, with a younger age of menopause, less family history of breast cancer, fewer positive estrogen and progesterone receptors, higher rate of cigarette smokers, more Medicaid insured, and more single and divorced individuals compared to Caucasian Americans (p < 0.05). Multivariate analysis found no difference between the races for stage 0, stage 2 and stage 4. African Americans had significantly less stage 1 (RR 0.80, 95% CI: 0.67-0.96), less combined stage 0 and 1 (RR 0.75, 95% CI: 0.63-0.89) and more combined stage 3 (RR 1.50 95% CI: 1.11-2.01)., Conclusion: Although there was no difference among the races for topography, morphology and laterality of their breast cancers, African-American race is a predictor of more advanced stage at diagnosis.