Brian's Song (1971) and Germ Cell Cancer

The film tells the true story of two Chicago Bears running backs, Gale Sayers and Brian Piccolo, who in 1967 became the first Black and white roommates in the NFL.

It starts as a rivalry. Piccolo is the undrafted grinder; Sayers is the prodigy. It turns into a friendship when Piccolo drags Sayers through rehabilitation after a knee injury, and then complicates itself again when Piccolo is pushed back down the depth chart by the man he helped.

In November 1969, during a game against Atlanta, Piccolo takes himself off the field. He has never done that. Tests find a tumour in his chest, and surgery follows. He returns to hospital repeatedly through the winter and spring.

A month before he dies, Sayers accepts the George S. Halas Award and gives it to Piccolo instead, asking the room to pray for him. Piccolo died on 16 June 1970, aged twenty-six. The closing narration insists he be remembered for how he lived.

The ending is discussed below.

The broad facts hold. The illness announced itself as breathlessness during a season. There was chest surgery that took part of a lung. The disease came back and spread. He died in June 1970 at twenty-six. Sayers's speech happened.

The film is also good on how serious illness lands in a workplace. Teammates who do not know what to say. A coach who quietly keeps a dying man on the payroll. Hospital visits where nobody can find the register.

And, without ever commenting on it, the film shows how fast a supremely fit young man can go from full function to dying. That is genuinely characteristic of an aggressive germ cell tumour treated before modern chemotherapy existed.

Its refusal to turn an interracial friendship into a lecture has aged better than most 1971 television.

The film sanitises the illness badly. Piccolo keeps his hair and a wry composure throughout, and dies neatly.

The record is harsher. Reporting by STAT News in 2022, drawing on Jeannie Morris's book about him, describes constant facial pain because the tumour had spread into his jaws and teeth, and procedures his own account called torture. Morris quotes him as feeling simply drained, of everything.

The treatment was equally brutal. After the first operation he had a radical mastectomy, an extremely disfiguring procedure normally used for breast cancer. The cancer returned in his chest wall about four months later. A second operation took the rest of the diseased lung and the pectoral muscle. Cobalt radiotherapy, which he finished in May 1970, did not hold it. In early June the disease was found in his liver and elsewhere.

None of that is on screen, and the omission is not neutral. A film about a young man dying of cancer that shows no suffering teaches viewers that dying well is a matter of character.

The film never says what he had. Piccolo had embryonal cell carcinoma, an aggressive germ cell cancer of the kind that usually starts in a testicle. In his case it had grown into a large mass in the chest behind the breastbone before anyone found it.

So a viewer learns nothing about germ cell tumours, and nothing about the sign that usually comes first.

Testicular cancer typically announces itself as a painless lump or swelling, or a change in the firmness or size of one testicle. Some men notice a dull ache or a feeling of heaviness in the scrotum or lower abdomen.

The absence of pain is the problem. Pain forces action; a lump that does not hurt can be tolerated for months, and often is.

When a germ cell tumour has already spread to the chest, as Piccolo's had, the first symptoms may instead be breathlessness, cough or chest pain. In a fit young athlete those get read as a training injury or a chest infection, which is exactly what happened here.

The US Preventive Services Task Force recommends against screening for testicular cancer in adolescent or adult men. That is a grade D recommendation.

The reasoning is worth understanding rather than resenting. The Task Force found inadequate evidence that examination by a doctor, or taught self-examination, detects the disease any earlier than men noticing it themselves. The disease is uncommon, and it is highly curable at any stage: the Task Force states that over 90% of all newly diagnosed cases of testicular cancer are cured.

So the recommendation is not "ignore your body". It is that a formal screening programme adds nothing to what a man notices anyway. What matters instead is the time between noticing and being seen.

Piccolo was treated in 1969 and 1970 with surgery and cobalt radiotherapy. Set that against the modern figure above and the difference is stark, which is the strongest argument this film can make to a viewer today: a new testicular lump, swelling or ache that lasts more than a couple of weeks should be examined now rather than after the season.

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Brian's Song still works as a film about friendship. As an account of illness it is a period piece, and its silences are the period.

It cannot tell you what he had, what it did to him, or what any of it would mean now. What it can do is put a name and a face on a cancer that mostly affects young men who feel invincible.

If that is you, or someone you live with, the useful action is small and immediate. A painless lump is still a lump. See possible warning signs and screening.

• US Preventive Services Task Force — Testicular Cancer: Screening
• NCI PDQ — Testicular Cancer Treatment (Patient Version)
• STAT — 'Brian's Song' at 50 still offers lessons about cancer for today (2022)

This page discusses Brian's Song for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].