{"publication_id":"054f72de-a886-4506-a529-11d92344f009","traces":[{"claim_id":"claim_1","claim":"This synthesis tests the thesis that evidence for Telomere Cancer Effects is context-dependent, separating outcome-specific signals from broader claims and identifying the evidence gaps that should bound interpretation.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_2","claim":"Evidence-honesty note: The retained evidence has no direct interventional hard-endpoint evidence; indirect, review-level, adjacent, or mechanistic sources are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_3","claim":"This paper synthesizes evidence on telomere cancer effects across 25 included source papers and 826 high-confidence extracted claims.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_4","claim":"The evidence profile contains no sources classified primarily as direct interventional hard-endpoint evidence, 24 adjacent clinical sources, and 1 mechanistic or model-system source, with 3 cross-study disagreements across the evidence base.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_5","claim":"Positive study-level signals are summarized in the frailty outcome class; null signals are summarized in the immune and inflammation and mechanism outcome classes; negative signals are summarized in the dosing and pharmacokinetics outcome class; mixed or heterogeneous signals are summarized in the contextual adjacent evidence, mortality and survival, and longevity outcome classes. The paper therefore reports a source-directness and outcome-class map rather than a pooled effect.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_6","claim":"The conclusion is narrower: the retained evidence maps associations, mechanisms, and candidate endpoints for follow-up; it does not establish clinical benefit, therapeutic actionability, or anti-aging efficacy.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_7","claim":"For Telomere Cancer Effects, what does the retained evidence show about prognostic or risk-marker associations, causal or mechanistic evidence, treatment or intervention relevance across prognostic and survival-marker evidence, treatment or intervention-response evidence, causal-risk and Mendelian-randomization evidence, and are those outcome-class source-level signals directionally consistent enough for clinical actionability once unclear direction coding, adjacent/contextual source roles, and directness limits are considered?","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_8","claim":"This manuscript is reported as a Thin-corpus evidence brief. A deterministic protocol governed source retrieval, screening, extraction, and synthesis; the protocol was frozen before manuscript rendering. The full audit trail is in the supplementary `methods_pack.json` and the timestamped submission directory `synthesis-telomere_cancer_effects-v06-DAILY-2026-06-28T00-39-28Z`.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_9","claim":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_10","claim":"Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_11","claim":"Evidence-tension synthesis: claims grouped by outcome class (contextual adjacent evidence, dosing and pharmacokinetics, frailty, immune and inflammation, longevity, mechanism, mortality and survival); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_12","claim":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified.","candidate_sources":[{"source_id":"source_1","study":"Shorter telomere length as a prognostic marker for survival and recurrence in breast cancer: a systematic review and meta-analysis","doi":"10.37349/etat.2025.1002289","url":"https://doi.org/10.37349/etat.2025.1002289","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"},{"source_id":"source_2","study":"Telomere lengths in women treated for breast cancer show associations with chemotherapy, pain symptoms, and cognitive domain measures: a longitudinal study","doi":"10.1186/s13058-020-01368-6","url":"https://doi.org/10.1186/s13058-020-01368-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_3","study":"A Natural Astragalus-Based Nutritional Supplement Lengthens Telomeres in a Middle-Aged Population: A Randomized, Double-Blind, Placebo-Controlled Study","doi":"10.3390/nu16172963","url":"https://doi.org/10.3390/nu16172963","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_4","study":"The association of epigenetic age acceleration with internal smoking dose, risk of lung cancer, and all-cause mortality in cigarette smokers: the Multiethnic Cohort study","doi":"10.1186/s13148-026-02137-6","url":"https://doi.org/10.1186/s13148-026-02137-6","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"primary"},{"source_id":"source_5","study":"Systematic review of Mendelian randomization studies on risk of cancer","doi":"10.1186/s12916-022-02246-y","url":"https://doi.org/10.1186/s12916-022-02246-y","support_kind":"candidate_source_row","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review-level"}]},{"claim_id":"claim_13","claim":"Source directness breakdown: 0/25 retained sources directly address the stated topic and aging-relevant hard endpoints; 25/25 are adjacent, contextual, review-level, or mechanistic and are used only to bound interpretation. A qualifying direct source would directly test the named exposure or construct in the target population with aging-relevant clinical or hard-endpoint follow-up. Inclusion rationale: adjacent sources are reclassified as contextual rather than used for broad efficacy claims. 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