We describe factors associated with an initial diagnosis of stage IV breast cancer to identify segments of Oklahoma's population that need earlier screening. We obtained data from the Central Oklahoma chapter of Susan G. Komen for the Cure and from the Oklahoma Central Cancer Registry. All analyses were cross-sectional and ecologic. The distributions of breast cancer stage at diagnosis for ten central Oklahoma counties were analyzed with respect to age group, race/ethnicity, insurance status, family income, and the percent of women who reported [not] receiving a mammogram in the previous twelve months. The percentage of African American women diagnosed with stage IV disease (7.8%) was nearly double that in white (4.2%) and other races (4.1%; p < 0.01). After controlling for confounding variables, the proportion of women diagnosed with breast cancer at stage IV was still higher among African American than among white females (p < 0.01) and females aged 65+ years (p = 0.02). The availability of breast cancer screening services should be increased among African American women in central Oklahoma.