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A 53-year-old woman presents with a 1-cm invasive carcinoma of the breast, detected on mammography. She feels well and has no other symptoms. On examination the lump is palpable, and there are no axillary lymph nodes. Which of the following is the most appropriate local therapy for her tumor?
simple mastectomy with axillary dissection
radiation therapy to breast and axilla
local excision plus radiation therapy
local excision and axillary dissection followed by radiation therapy
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