Hello Jason !
Thank you for posting on Microsoft Learn.
There isn’t a switch today that tells Azure en-US neural voices to drop the "and" in cardinals. The US/UK preference here is controlled by the service text-normalization rules, and SSML<say-as interpret-as="number|cardinal"> doesn’t expose an option to change that behavior. https://learn.microsoft.com/en-us/azure/ai-services/speech-service/speech-synthesis-markup-pronunciation
This same issue has been raised before and there isn’t an official toggle exposed today. If this is critical for you, open a support ticket and reference the US cardinal formatting request so it can be prioritized by the Speech team.
For other numeric types, use the dedicated modes to avoid odd readings: number_digit (read digits), telephone, currency, address, date/time, fraction... These do work as intended in en-US. https://learn.microsoft.com/en-us/azure/ai-services/speech-service/speech-synthesis-markup-pronunciation
You can avoid commas in plain numerals when you want a number since commas can cause segmentation or pauses (“39,873” may split). Prefer 39873 wrapped in <say-as interpret-as="cardinal">.
For specific troublesome numbers, wrap the original digits in <sub alias="thirty-two thousand seven hundred sixty-eight">32768</sub>. This forces the US style. (Trade-off: more billable characters because the alias text counts.)