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A 53-year-old woman presents to the clinic for evaluation of a new left breast lump that she discovered 1 week ago. The nodule is not painful; she feels well and has no other symptoms. On physical examination the lump is palpable, and there are no axillary lymph nodes. The mammogram confirms the presence of a 1-cm breast mass which on biopsy is positive for invasive breast cancer. Which of the following is the most appropriate local therapy for her tumor?

Asimple mastectomy with axillary dissection
Bradiation therapy to breast and axilla
Clocal excision plus radiation therapy
Dlocal excision and axillary dissection followed by radiation therapy
Medicine
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