Kim Ritchey, of the Children's Hospital of Pittsburgh of UPMC and president of the American Society of Pediatric Hematology/Oncology, says each state's caseload is so small that minor variations may appear to be significant when they're not. He also says state-by-state comparisons yield no meaningful patterns.
Li holds out hope that future studies, including a CDC trend analysis study of childhood cancer rates from 2001 to 2008, will yield more useful information. "I'm afraid there's no solid conclusion on childhood cancer [causes]," he says. "If we knew, we would share it with you."
There's been plenty of speculation, often centering on environmental factors – such as exposure to toxins, pesticides and cleaning chemicals – or foods a mother ate during pregnancy. Ritchey dismisses those theories, especially as they relate to leukemia. "The bottom line is there's never been any environmental [factor] that's been proven to be a cause of childhood ALL [acute lymphocytic leukemia]," Ritchey says.
He adds that he often finds himself trying to diffuse the anxiety of parents who blame themselves and feel they did something wrong – such as giving their child something harmful to eat or exposing him or her to someone with leukemia. Ritchey reassures them that the disease isn't contagious. "I try to say, 'No, that's not the case.' We really do think it's a genetic mistake, and it's nothing [you could] control."
Focusing on the Fight
Ellyn says she doesn't think about the why. It's the one question she doesn't ask.
"It doesn't do me any good. There's nothing we can do to change this. It's not as if you have an adult who gets liver cancer because they're a drinker or who gets lung cancer because they're a smoker, and they can look back and say, 'I shouldn't have done that.' Gabriella didn't do anything," she stops, and then repeats, "She didn't do anything."
Gabriella started radiation treatment last year, two weeks before Thanksgiving. Ellyn, 45, was about to start a new job, but decided that Gabriella needed her at home instead. Her husband Mark, a 41-year-old real estate agent, also wanted to stay home, but Ellyn put the kibosh on that plan, knowing it would only set off alarm bells for Gabriella. She said life needed to continue like "normal."
For the next six weeks, it was anything but. Monday through Friday, Ellyn drove her daughter an hour to Inova Fairfax Hospital for radiation sessions. Not allowed to stay in the treatment suite with her daughter, Ellyn sat in the waiting room crocheting a hot pink scarf for Gabriella's 10th birthday.
"When it ended, there's supposed to be such this joy, but as it was coming to a close, I had such anxiety and wasn't sleeping," Ellyn recalls, saying she felt helpless and wanted to do more. Next came a year-long clinical trial involving an experimental drug. While Gabriella's health remains uncertain, thanks to the intensive treatment her inoperable tumor has shrunk about 80 percent – to the size of a pecan.
Talking with Gabriella, you'd never know she's been in the hospital more than most 70-year-olds. Her bubbly personality masks all the scans, needles, vomiting and fatigue she's endured. "I like colors," she chatters, perched on the edge of her couch dressed in a black dress with lime green, red, blue, orange and yellow ruffles. "I like bright purple. And I love stuffed animals," she says, giggling, as she wraps herself in a monkey her size. "I have about a million."
The fifth grader also loves school, particularly language arts. Gabriella once used to write poems about fairies. Now she writes about the other children she meets in the hospital – the friends she's made and lost along the way.