Patients at high risk for developing breast cancer and those with early stage breast cancer may have treatment options in addition to systemic therapy for the prevention and treatment of this disease in the near future. Methods of intraductal diagnosis and treatment of breast cancer, including nipple aspiration, ductal lavage and ductoscopy, are discussed in this review. Advances in this field include improvements in equipment and techniques, more reliable biomarker assessment and improved targeted therapies. As a result of these advances, intraductal treatment in high-risk populations is being investigated in clinical trials.