Cries and Whispers (1972)

In a red-walled Swedish manor near the turn of the twentieth century, Agnes is dying of cancer of the womb. Her sisters, Karin and Maria, have come home to sit out her last days. The household is kept running by Anna, the maid, who lost her own small daughter.

Bergman moves between the sickroom and flashbacks that open each woman's private history. Karin's marriage is frozen and self-lacerating. Maria has had an affair with the family doctor and a habit of charm without commitment.

Agnes's pain comes in waves. She gasps, sweats and calls out, and it is Anna, not her sisters, who holds her.

After Agnes dies, the film slips into a waking nightmare in which her body speaks and asks the sisters to stay with her. Both refuse. The estate is settled and Anna is dismissed without a keepsake. The last scene is Anna reading Agnes's diary: an afternoon in a garden swing with all three sisters, briefly happy.

The ending is discussed below.

The physical reality here is unflinching, and it is a picture of what dying looked like when there was nothing to give.

Agnes's pain is not tidy. It arrives in surges. It frightens her, strips her of composure, and cannot be talked down. She is not serene and she is not brave in the way films usually require.

Around 1900 that was simply the situation. There was no reliable pain control, no anti-sickness medicine worth the name, and no specialty whose job was comfort. The film is a period document in that sense, and it should not be read as a picture of modern end-of-life care.

Bergman also catches something that has not changed. A dying person can be surrounded by relatives and profoundly alone. And families often use a deathbed to rehearse old grievances rather than settle them. The sisters' flinching reads as ordinary human failure rather than villainy, which is why it is hard to watch.

The film is exact about the labour: the turning, washing, holding and sitting through the night. It is just as exact about who does it.

Anna, the paid servant, is the only person who touches Agnes without recoiling. Then the estate is settled and she is sent away with nothing.

That observation still holds. Serious illness redistributes intimacy along lines of duty and employment rather than blood. Much of the hands-on work of dying is done by care assistants, agency staff and one family member who did not volunteer, while relationships that look closer on paper keep their distance.

If you are the person doing it, this film is unusually respectful of that. It is also unsparing about how little recognition it earns.

There is no diagnosis scene. No doctor manages symptoms. Nobody discusses what could or could not be done, and no treatment is ever named.

That is a deliberate artistic choice, and it means a viewer learns nothing about how uterine cancer is found or treated. Agnes also stays lucid and expressive between crises, which serves the drama. Advanced disease more often brings drowsiness, confusion and long stretches of withdrawal.

So the useful material has to come from outside the film.

Cancer of the womb usually means endometrial cancer, which starts in the lining. Rarer uterine sarcomas begin in the muscle wall.

NCI's headline is that the signs are unusual vaginal bleeding or pelvic pain. In more detail, it advises checking with a doctor about:

• Vaginal bleeding or discharge not related to periods.
• Vaginal bleeding after menopause.
• Difficult or painful urination.
• Pain during sex.
• Pain in the pelvic area.

One of those carries far more weight than the rest. Bleeding after menopause is never normal, and it is the reason most endometrial cancers are caught early. NCI notes that about 85% of endometrial cancers are diagnosed at a low stage because of symptoms, and that survival is high.

That statistic is the argument for reporting it the first time it happens, rather than waiting to see whether it happens again.

The main risk factors NCI lists are oestrogen-only hormone replacement therapy after menopause, tamoxifen taken to treat or prevent breast cancer, obesity, metabolic syndrome, type 2 diabetes, never giving birth, starting periods early, late menopause, polycystic ovary syndrome, endometrial hyperplasia, a first-degree relative with endometrial cancer, and genetic conditions such as Lynch syndrome. People with Lynch syndrome are managed under separate specialist advice.

This is the most common misunderstanding about the disease, and it is worth stating plainly.

NCI is explicit that because endometrial cancer begins inside the uterus, it does not usually show up in the results of a Pap test. A Pap test screens for cervical cancer. A normal one says nothing about the lining of the womb.

There is also no screening test for uterine cancer in women at average risk. NCI's evidence review finds no evidence that screening by transvaginal ultrasound reduces deaths from endometrial cancer, and inadequate evidence for screening by endometrial sampling. Screening women without symptoms mainly produces false positives, and those lead to biopsies that carry their own risks of discomfort, bleeding and infection.

So detection depends entirely on symptoms being reported and investigated. If you have had post-menopausal bleeding and were reassured by a recent normal smear, that reassurance was about a different organ. Go back.

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Cries and Whispers is a great film and an unbearable one, and it is about dying rather than about cancer.

Its subject is what people do when someone they love is in pain and they cannot fix it. Most of them get it wrong, and the film does not forgive them for it, which is why it has lasted.

The medical point sits entirely outside the frame. Endometrial cancer is one of the cancers most often caught early, and it is caught early because of one symptom. Bleeding after menopause needs investigating. See possible warning signs and screening.

This page discusses Cries and Whispers 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].