In 1999, at age 58, with no family history of the disease, Spinale was diagnosed with Stage 1 breast cancer. After a lumpectomy and radiation, Spinale thought she was in the clear. But in December 2008, Spinale was diagnosed with Stage 4 breast cancer that her doctors said metastasized to her lungs, liver, and brain.
It is unclear whether Spinale's cancer is associated with her having taken hormone therapy.
"When I blamed the HRT for the reason why I got breast cancer, it was inconclusive as far as they [my doctors] were concerned," said Spinale. "I don't remember being told of any side effects of HRT, except being told that it would help the hot flashes."
Chlebowski's study initially warned of a link between combination hormone replacement therapy and breast cancer in 2002. Since then, many doctors have prescribed a variety of combinations, including lower-dose combinations of estrogen and progestin, or estrogen alone, without knowing what type of therapy might offer the greatest benefit to women. Many doctors say they now prescribe lower doses of the hormones at shorter intervals.
"We significantly reduced use of HRT when the link to HRT first came out [in 2002]," said Dr. Randy Wexler, assistant professor of family medicine at Ohio State University.
"There is still a role for hormone therapy," said Dr. Hugh Taylor, director of reproductive endocrinology at Yale School of Medicine.
The concern lies mainly with the combination of estrogen and progestin and not on estrogen alone, according to Taylor.
"With low doses of of estrogen we can get away with small and infrequent progestin use," said Taylor. "Let's not throw the baby out with the bath water. Estrogen therapy is the only thing that works well and estrogen is not the cause of breast cancer."
But there's no scientific evidence that any variation of hormone therapy at any length of time provides a safer alternative. Litton said non-hormone therapies, such as antidepressants or acupuncture, may provide some women some benefit.
"I don't think that we can counsel patients saying that it's safe to take for a shorter time at a lower dose," said Litton. "I think that for the general practitioner or gynecologist, it should be a drug of very last resort."
According to Dr. Dian Ginsberg, obstetrician and gynecologist at Children's Memorial Hermann Hospital and in and in private practice in Houston, TX, lifestyle changes during a women's premenopausal years may help women ease through their symptoms and divert hormone therapy altogether.
"I hope that as we learn more about the hormone replacement pill not being the answer, we can maybe approach the woman differently in her 30s and 40s," said Ginsberg.
Still, she said the type of therapy depends on a woman's personal history and understanding the risk. And before abandoning hormone therapy, women should talk to their doctor.
"Don't throw your hormones out," said Ginsberg. "Call your physician, go in, learn a little bit more about this study, go over your own medical background, and see a good way, potentially, to wean off your hormone."