Preheat your oven to 350°F (175°C) and grease a 9x13-inch baking dish.

Bring salted water to a boil in a large pot, add elbow macaroni, and cook until just al dente, about 8 minutes. Drain and set aside.

In a skillet, brown 1 lb of ground beef over medium-high heat for 6-8 minutes. Add diced onion, diced bell pepper, and minced garlic, cooking for 5 minutes until vegetables are soft.

Stir in tomato sauce, cream of mushroom soup, Worcestershire sauce, and season with salt and pepper. Simmer for 3-4 minutes.

Add the cooked macaroni to the skillet and stir to combine.

Transfer the mixture to the greased baking dish, top with shredded cheese, and sprinkle with crushed crackers or breadcrumbs if desired.

Bake in the oven for 20-25 minutes until the cheese is melted and bubbly.

Remove from the oven and let it rest for 5 minutes before slicing.