2 tablespoons olive oil
1 pound sweet Italian sausage, casings removed
½ teaspoon red pepper flakes
1 cup chopped onion
3 cloves garlic, minced
1 28-ounce can crushed Italian plum tomatoes in puree
½ cup heavy cream

1 pound farfalle (bow-tie shaped pasta)
½ cup chopped fresh basil
Freshly grated Pecorino Romano cheese

Heat oil in a large, heavy skillet over medium-high heat. Add sausage and red pepper flakes. Sauté until sausage is no longer pink, breaking up with the back of a fork, about 5 minutes. Add onion and garlic; sauté until onion is tender and sausage in browned, about 3 more minutes. Add crushed tomatoes and heavy cream. Reduce heat to low and simmer until sausage mixture thickens, about 3 minutes. Season to taste with salt and pepper.

Meanwhile, cook pasta in a large pot of boiling salted water until al dente. Drain pasta reserving 1 cup of the pasta water. Return pasta to same pot. Add sausage mixture and toss over medium-low heat until sauce coats pasta, adding reserved pasta cooking water by ¼ cups as needed. Transfer pasta to serving dish. Sprinkle with basil and Romano cheese.