SLE often follows a relapsing and remitting pattern of disease. The ability to identify those patients in whom a flare is likely allows either a proactive increase in therapy or instigation of more stringent monitoring. No single predictive marker for lupus flare has yet been identified. Perhaps the most recognised link is that between raised dsDNA titre and/or low serum complement (C3, C4 and C1q) and the development or flare of lupus nephritis. 28,29 An increase in dsDNA titre, or the development of blood dyscrasia (anaemia, lymphocytopenia or thrombocytopenia) can also predict flare in lupus cohorts and has been reviewed by Bertsias et al. 30 A combination of clinical (disease activity) and laboratory features (full blood count, serum complement) is therefore recommended for monitoring SLE patients, as reflected for example in the 2010 EULAR guidelines for the monitoring of lupus patients both in clinical practice and in observational studies. 31
Invasive breast cancer requires multimodality management that is specific to the stage of the disease. The majority of patients with invasive breast cancer have ductal breast cancer and, less commonly, lobular breast cancer. While there is a slight difference in the natural history of lobular and ductal breast cancer, patients with these two different pathologies are treated in the same way. The management sections that follow, aside from the section about less common histologies , refer in particular to those with invasive ductal or lobular breast cancer.