Smashing Walnuts: The Fight Against Childhood Cancer

Child cancer is growing, yet experts can’t explain why. Gabriella Miller is one of the unlucky ones.

Gabriella Miller smashes a walnut on her porch in Leesburg, Va. The 10-year-old was diagnosed with brain cancer last November and started smashing walnuts to represent the battle against her tumor of the same size.

Gabriella Miller smashes a walnut on her porch in Leesburg, Va. The 10-year-old was diagnosed with brain cancer last November and started smashing walnuts to represent the battle against her tumor of the same size.

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As summer's end approaches, most 10-year-olds might dash outside on a warm Friday evening with a bike or a bat and ball. Not Gabriella Miller. Gabriella lugs a dented blue frying pan in one hand and a bag of walnuts in the other.

She crouches down on the porch, touching her knees to her chest. Before her is a lime green plastic cutting board her mom set on the ground. Emerald green and magenta toenails peek out from her fuzzy pink frog pajamas. Silver flip-flops make her seem at least an inch taller, but it's not height Gabriella needs to gain. Just 42 pounds, most girls her age are about 30 pounds heavier.

She plucks a walnut from the plastic bag and sets it in the center of the board, just as she's done in Philadelphia, a Chicago suburb, on the National Mall and even on top of the Eiffel Tower in Paris. Tonight, she's home in Leesburg, Va., engulfed in the warm glow of the porch light, but her purpose is the same. Gabriella looks into her father's iPad, her hazel eyes flashing, and says the words she's repeated in Philadelphia and Chicago and Paris. "Hi, my name is Gabriella Miller. I'm 10 years old, and I have brain cancer."

Raising her skinny arms above her head with its patches of mouse brown hair that were once nearly black, she lifts the pan and brings it down upon the walnut with surprising force.

Fragments scatter into the darkness, just as they have nearly every night since last November, when she began the ritual attack on this proxy for her tumor. Back then, Gabriella's cancer was just the size of that walnut. With radiation and experimental drugs, her tumor has shrunk. Not so the incidence of cancer in children. For reasons even experts don't understand, cancer rates in young children are, ever so slowly, growing.

The Rise in Childhood Cancer

Childhood cancer is the leading cause of disease-related death among children ages 1 to 14. To put it in perspective, about two classrooms full of kids receive a cancer diagnosis each day. About 10 to 20 children out of every 100,000 develop cancer annually, according to the National Cancer Institute. Though it may sound like a relatively small ratio, the rate has been slowly rising since the institute began tracking the rate nearly four decades ago. In 1975, researchers recorded about 11 cases per 100,000 children. In 2010, they reported 16.8 cases per 100,000.

While there are a dozen potentially deadly childhood cancers – lymphoma, neuroblastomas, and bone cancer, to name a few – two lead the pack, striking the most kids in recent decades: leukemia and brain cancer.

The incidence of leukemia has risen from 30.2 cases per million in 1975 to 42.2 cases per million – 34 percent of all childhood cancers – in 2010. The cancer begins in the bone marrow, where oxygen-carrying red blood cells and infection-fighting white blood cells are born. Acute lymphocytic leukemia, the most common childhood leukemia, develops when healthy white blood cells, or lymphocytes, multiply wildly and crowd out normal cells. Brain cancer, on the other hand, occurs when cancerous cells begin massing into a tumor that invades healthy brain tissue. This can cause headaches, nausea, vomiting, or a change in vision, hearing, memory or balance. A relatively rare cancer overall, the rate of brain cancer has remained steady since the mid-'80s when MRIs were introduced and used to diagnose the disease. Brain tumors are more common among adults, yet they still are found in about 4,100 kids each year in the U.S.

Gabriella is one of the unlucky ones, but she's determined to battle the disease.

She calls herself a "childhood cancer warrior" and has launched a one-child campaign on behalf of the estimated 12,060 children younger than 14 who were diagnosed with cancer last year.

"When a parent has a nightmare about their child, it's not about a doctor saying, 'Your child has cancer,'" says Gabriella's mom, Ellyn Miller. "It's about you can't find your child, or your child is hurt. But it's never about cancer. That's so above and beyond horrific, that it doesn't even enter into a realm of possibility."