There were significant state variations in racial and ethnic disparities in TNBC incidence in this cohort study, with Black women in Delaware, Missouri, Louisiana, and Mississippi having the highest rates among all states and racial and ethnic populations. More research is needed to identify factors contributing to the significant geographic variations in racial and ethnic disparities in TNBC incidence in order to develop effective preventive measures, and social determinants of health contribute to the geographic disparities in TNBC risk, according to the findings.