The authors reviewed 645 gallbladder operations performed by one of them during a 22-year period to determine whether cancer of the gallbladder occurs frequently enough in private practice to be considered a real threat to life. Of 320 patients who were 50 years of age or older having gallstones, there were 20 with carcinoma—an incidence of 6%. Because of delays, removal of the gallbladder was possible only in 8 of the 20 patients. For 18 of the 20 patients the average survival time was 151 days; the 2 surviving at the time of writing had metastases. Since 1 in 16 patients 50 years of age or older, having gallstones, will develop carcinoma, the authors consider carcinoma a real hazard in gallbladder disease and plead for earlier surgery.