Make the cream sauce by melting the butter in a saucepan. Stir
in the flour and over low heat, stirring constantly, mix for about
1 minute. Gradually add the milk and stirring constantly, cook
until thickened about 4 minutes. Add the mustard and
horseradish (if using), and the cheese, stirring until melted. Fold
in the ham and macaroni. Top with buttered crumbs.
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