The Broken Circle Breakdown (2012)

Didier is a Flemish banjo player in love with American bluegrass. He meets Elise, a tattoo artist. Their romance is told out of order, cut against the band they play in together.

Elise gets pregnant, and they raise their daughter Maybelle at Didier's converted farm. Shortly after Maybelle turns six she is diagnosed with cancer. The film moves between the happy years before and the months of treatment: corridors, chemotherapy, a shaved head, a hopeful remission, then relapse. Maybelle dies within about a year.

Grief pulls the parents apart. Elise looks for meaning in an afterlife and in signs from her daughter. Didier turns his loss into public rage, and breaks off a concert to denounce religious opposition to stem-cell research. Elise later changes her name, then takes an overdose. She is left brain-dead, and Didier agrees to withdraw life support. The band plays around her bed.

Spoilers throughout. Maybelle's illness and what follows it are both discussed below.

The film shows chemotherapy, hair loss and isolation precautions, and never says what Maybelle has. That is a choice, and it makes the film a portrait of childhood cancer in general rather than an account of one disease.

It also means this page cannot tell you what her treatment should have looked like. What it can do is take the general subject seriously, because most parents watching will not know it either.

Didier's monologue is the film's most quoted scene and its least accurate one. He rages at religious opposition to embryonic stem-cell research, implying that politics cost his daughter a cure.

For the blood cancers where a transplant applies, that is not where the cells come from. Donor stem cells for transplant come from bone marrow, from adult volunteer donors, or from umbilical cord blood. They are not the embryonic cells the argument is about.

The scene works as grief looking for somewhere to land. It does not work as a description of what was available.

Leukaemias are the most common cancers in children. NCI reports that the most common types diagnosed in children and adolescents were leukaemias, then brain and other central nervous system tumours, then lymphomas.

Because leukaemia leads that list, its early signs are the ones worth knowing. NCI's page on childhood acute lymphoblastic leukaemia says to check with a doctor if a child has:

• Fever.
• Easy bruising or bleeding.
• Flat, pinpoint, dark-red spots under the skin caused by bleeding.
• Weakness or fatigue.
• Pale skin, or looking pale.
• Bone or joint pain.
• Shortness of breath or trouble breathing.
• Painless lumps in the neck, underarm, stomach or groin.
• Pain or a feeling of fullness below the ribs.
• Loss of appetite, or weight loss.
• Abdominal pain.
• Frequent infections, or infections that do not go away.

NCI adds the sentence that matters most: these symptoms may be caused by problems other than leukaemia, and the only way to know is to see a doctor. Almost every child with that list has something ordinary.

With solid tumours, parents may notice other things instead. A lump or swelling that does not settle. Morning headaches with vomiting. Changes in vision or balance. An unexplained limp.

This is the fact a family audience most needs, and no film says it.

There is no cancer screening programme for children at average risk. No test is recommended for a well child. Childhood cancer is found because somebody took a persistent, unexplained symptom seriously and asked for a blood count or an examination.

Regular surveillance does exist, but only for children with a known inherited condition that raises cancer risk, and it is arranged through genetics services.

So the practical rule is small and unglamorous. A symptom lasting more than a couple of weeks with no explanation gets a doctor's assessment. So does any unexplained bruising or bleeding.

The domestic texture is excellent:

• Ordinary routine collapses overnight.
• Parents perform cheerfulness in front of the child.
• Hair loss, and the wig.
• Isolation precautions and constant handwashing.
• Treatment as months of attrition rather than one dramatic operation.

It captures the false summit of remission and the particular flattening of relapse. And it is honest that a child's death does not bond a couple. Bereaved parents often grieve on incompatible timetables and in incompatible languages.

Treatment is a montage. And roughly a year from diagnosis to death is faster than the usual course of many childhood cancers, several of which are treated for two years or more.

No advertiser funds this page and there is nothing here to buy. If the list of childhood warning signs was worth having, you can help keep it free for other parents. Support our work.

The Broken Circle Breakdown is a devastating film about two people grieving differently. As a medical account it is deliberately blank, and its one confident clinical claim, about stem cells, is wrong.

The part to keep is the ordinary one. There is nothing to screen a well child for. A symptom that persists without explanation is the whole early-warning system, and a blood count is a cheap way to start.

• https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet
• https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq
• https://www.cdc.gov/cancer/prevention/screening.html

This page discusses The Broken Circle Breakdown 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].