Breast cancer screening is effective in early disease detection. Diagnosis of disease at an early stage results in higher cure rates and less need for aggressive treatments. Patients from rural areas have lower breast cancer screening rates and poorer cancer outcomes than urban patients. This study investigated the extent to which U.S. rural residents are diagnosed at more advanced stages of disease for breast cancer compared to non-rural residents. We found that a greater proportion of rural patients received an initial breast cancer diagnosis at a late stage compared with urban patients (14.7% compared to 13.2%, respectively) and that patients living in remote small rural counties had the highest rate of late-stage breast cancer at diagnosis (15.5% in remote small rural counties vs. 13.2% in metro counties). Other factors such as Black race and being uninsured were also associated with late stage at diagnosis. These patterns have persisted over time and suggest areas for policy change.