Objectives: To report the incidence of incidental gallbladder cancer after elective cholecystectomies in a secondary SUS hospital, comparing it with the literature and reviewing the risk factors and management related to this condition. Material and Methods: Unicentric, retrospective, non-randomized and observational study of patients who underwent cholecystectomy surgery from January to December 2024 at Hospital José Martiniano de Alencar, Fortaleza, Ceará. Patients who returned for postoperative evaluation of the surgical specimen were included and those who were lost to follow-up were excluded. Results: Of the 1078 eligible patients, 934 were female and 144 were male, all of whom underwent surgery for symptomatic cholelithiasis. Four cases of incident gallbladder cancer were diagnosed, representing an incidence of 0.37%. Three of these cases were classified as low-grade intraepithelial neoplasia, all in female patients, with a mean age of 53 years and without the need for additional surgery. The fourth case was identified in a young male, operated on for a 1cm polyp, but a mass was found intra-operatively, with histopathology confirming pt2a neoplasia and cystic duct involvement, who underwent rescue surgery at 3 weeks, but with evidence of metastatic disease. a factor that must be taken into consideration in the study is the high rate of 11.05% loss to follow-up of patients who did not return for postoperative evaluation. Conclusions: The incidence of incidental cancer found in elective cholecystectomies was low, but we emphasize that its diagnosis is of great importance due to the prognosis of the disease and for adequate postoperative management. Attention to risk factors such as advanced age, cholelithiasis and polyps greater than or equal to 1 cm can help identify patients with a greater chance of developing this condition. The management of incidental biliary cancer must be individualized, based on the clinical and pathological characteristics of each case.