569eP Gender equity in lung cancer clinical trials: The ENGAGE study

Methods: A systematic search of PubMed, Cochrane Library, ScienceDirect, and Google Scholar was conducted for English-language studies published between 2020 and 2025.Observational studies in adult populations from LMICs assessing long-term exposure to PM 2 .5 and/or PM 10 and reporting lung cancer incidence or mortality were included.Data on population characteristics, exposure, and adjusted risk estimates were extracted.Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model; heterogeneity was assessed using the I 2 statistic.Results: Twelve studies encompassing diverse LMIC populations were included.The pooled study-size population 1,550,333.Mean duration of exposure was 10.1 years.Meta-analysis showed a significant association between PM exposure and lung cancer risk (pooled HR 1.08, 95% CI 1.06-1.11;p<0.0001).Substantial heterogeneity was observed (I 2 =89.2%) due to variability in exposure sources and assessment methods; however, associations were directionally consistent for both PM 2 .5 and PM 10 .Conclusions: Long-term PM air pollution significantly increases lung cancer risk in developing countries.Integrating air quality interventions into prevention strategies can reduce this burden and advance health equality.These findings underscore the need for multidisciplinary, evidence-based approaches in global thoracic oncology.