A double antibody enzyme immunoassay was used to measure serum ferritin levels in several different control and tumor-bearing populations collected from two institutions. The control groups consisted of normal volunteers, smokers, and Latter Day Saints. No statistically significant differences were noted in ferritin levels between pairs of these groups. Differences were noted among the normal groups when separated on the basis of age and sex, with higher ferritin levels in individuals older than 32 years of age and in men. By one-way analysis of variance, most control groups and subgroups were shown to have significantly lower levels (P < 0.05) than the head and neck cancer group, with the exception of male smokers, who had levels comparable to male head and neck cancer patients. Serum ferritin levels were higher in head and neck cancer patients than in controls; however, there was no difference when compared with patients with other types of solid malignancies or when considering the anatomic site of the head and neck lesion. Ferritin levels were significantly (P < 0.05) higher in patients with advanced (Stages 111 and IV) cancer than in those individuals with Stage I or I1 cancer. In patients with no evidence of clinical disease 5 years after treatment, the ferritin level had essentially returned to normal. In a group of head and neck cancer patients followed longitudinally, a significant decline in ferritin levels (P < 0.05) was seen by 5 months after the completion of successful treatment. Furthermore, ferritin levels showed a tendency to increase or remain at high levels in patients with a poor prognosis and to decrease in those patients with a favorable prognosis, giving support to the contention that ferritin may prove to be a valuable tumor marker in head and neck cancer. Cancer 57:305-311, 1986. URING THE COURSE of tumor development, quan-D titative changes occur in the level of a variety of substances in serum. Such substances are collectively referred to as tumor markers or biochemical serum markers, and these can be classified as belonging to one of several major groups. Examples include oncofetal proteins (car-cinoembryonic antigen [CEA], alpha-fetoprotein [AFP]), hormones (adrenocorticotropin, chorionic gonadotropin, calcitonin), enzymes (prostatic acid phosphatase), or serum proteins (beta-2 microglobulin, fenitin). Many of these markers are elevated in diseases other than cancer, and are therefore considered nonspecific, but have been From the