Puleng Makhetha – I’m my own advocate

Puleng Makhetha tells her story of having breast cancer at age 32 and how she advocated for herself throughout the journey.

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Puleng Makhetha (38) lives in Fourways, Gauteng with her son, Thendo (1).

After accidentally feeling a lump in her breast, Puleng dismissed it but told her sister. It was Puleng’s sister who persisted she go to a doctor. The GP confirmed she felt something and referred Puleng for an ultrasound, which confirmed abnormalities. 

After consulting a breast specialist, in February 2019, a biopsy was done which confirmed HER2+ ER+ ductal carcinoma in situ (DCIS) breast cancer.

“I was only 32 at the time. It was so hard to digest, I stayed at home alone that day and only told my family the next day,” Puleng explains. 

Due to her age, Puleng requested genetic testing; it came out negative which meant that she didn’t have any gene mutations that could cause breast cancer.  

Clockwork treatment 

Discussions around treatment were like clockwork. Surgery was discussed, which was foreign to Puleng. She wanted to have a lumpectomy, but the breast specialist advised her that since she is so young, it’s best to have a bilateral mastectomy with reconstructive surgery. 

Puleng heeded her advice and had nipple-sparing surgery with immediate reconstruction (implants) in March. 

“I remember the plastic surgeon asking me if I was ready for this. My answer was, ‘No but I’m going to show up’,” Puleng says tearfully. 

Puleng admits it took her a long time to look at her new breasts in the mirror. “Even when I had the dressings changed, I would look to the side. I think I expected the bride of Frankenstein, but it turned out pretty good,” Puleng says.

Once further testing was done on the tumours that were removed, it was found that the cancer had become more invasive and now chemotherapy was needed. “I agreed to the proposed treatment as I didn’t want to face cancer again.”

In April 2019, Puleng started treatment which began with a discussion around fertility. Puleng still wanted to have children, however, due to the high-cost of freezing eggs, she opted to proceed immediately with treatment and pursue having a baby at a later stage. Her treatment included 12 weeks of chemotherapy, along with trastuzumab for a year, and a goserelin injection for two years, which shut down her reproductive system during chemotherapy.   

“I had pimples all over my face and my hands were constantly itchy so I consulted a dermatologist; a cortisone cream was prescribed. My sisters would take turns taking me to chemotherapy.” 

Once chemotherapy finished, she was prescribed tamoxifen for five years. 

Choosing to have a baby 

Puleng finished treatment and started the road to recovery. Two years later, in 2021, at the age of 34, she told her oncologist that she wanted to try and have a baby. He was supportive and stopped the tamoxifen but told her she would have to go back on tamoxifen once she had a baby and it would need to be for five years again. 

Since Puleng didn’t have a partner, she consulted a fertility specialist. “This consultation left me in despair and was one of the worst I ever had. Basically, he told me that due to treatment, my ovarian reserve was way lower than that of an average 34-year-old and that the eggs that remained were probably not of good quality.”

Thankfully, Puleng sought a second opinion. This specialist agreed that her chances were low but said she only needed one good egg. He wrote a motivation letter to her medical aid requesting Puleng have IVF through a sperm donor. Unfortunately, this also fell through as the co-payment of R30 000 needed to be an upfront payment. Puleng tried to negotiate a payment plan but it was denied. “I was devastated,” she says.

Conceiving naturally 

In 2023, Puleng formed a relationship and her partner was willing to help her have a baby. They noted her ovulation dates and Puleng fell pregnant on the first try. Unfortunately, the relationship didn’t last but Puleng will always have a deep appreciation for the father of her child. “I’ll always be grateful, he was sent for a specific reason.”

During and after the pregnancy, there was ongoing monitoring by her oncologist. 

In March 2024, Puleng had a caesarean section and her son, Thendo, was born at 36 weeks. Her mother and sisters were overjoyed and have been the most supportive of her having a child.

In June 2024, Puleng restarted tamoxifen as well leuprolide acetate, another GnRH agonist.

When asked how she is enjoying motherhood, she responds, “It’s a paradox, it’s hard but so rewarding and fulfilling. Plus, there is this little baby that is mine forever.”

To secure her son’s future, she applied for life cover but says she   has been denied cover as she has had cancer. “I feel discriminated against. I have asked my oncologist to write a narrative and explain that my treatment was successful, but it was still denied. Currently, I’m looking at other options.”  

Advocating for herself

Puleng goes on to say that it’s thanks to other survivors sharing their cancer journeys on social media that helped her advocate for herself. “It’s because of these videos that I asked for genetic testing, a bone density test, and a cardiology appointment. 

I would’ve been none the wiser if I didn’t learn about these risks. Hearing their stories also gave me hope for the future version of myself, to see there is life after cancer. I hope to do the same for others as advocacy to me is representing those who don’t know and educating them and spreading awareness. I hope to make the journey easier for the next person,” Puleng says.